Free eyelash transplant procedure

HairSite is proud to presents:
“Eyelash Transplant” Florida
Free eyelash transplant procedure offered
by world's renowned hair transplant surgeon
Dr. Alan Bauman in South Florida.

As one of the few surgeons worldwide who routinely performs Eyelash Transplantation and following a very successful live surgery workshop in Los Angeles last month, Dr. Bauman has been asked once again by a local TV station in south Florida to demonstrate his eyelash transplantation technique. We will be offering one or more free eyelash transplant procedure in December. A very limited number of consultation time-slots are available and will be filled on a first-come, first-served basis to qualified applicants. One or more patients will be personally selected by Dr. Bauman to undergo the eyelash transplant procedure at no charge, valued at US$6,000. For more info about the procedure, please read eyelash transplant facts.

Free Eyelash Transplant Procedure
South Florida
Screening Questionnaire
PRIVACY PROTECTED
Information will only be used by Bauman Medical for selecting the right candidates for the
free eyelash transplant procedure. We do not sell or share your information with third parties.

All Questions Must Be Answered, click SUBMIT when completed.

Are you male / female?

Age?

Available for an in-person medical evaluation prior to the procedure
if required ?

Available for eyelash transplantation procedure at Dr. Bauman's clinic
in Jacksonville, Florida ?

Available for post-operative follow-up appointment at Dr. Bauman's clinic if necessary?

Do you have scalp hair length >4inches in the back of your head?

Are you willing to sign a ‘photography release’ form allowing publishing/presenting of photos/video of yourself and the procedure for educational purposes?

Do you suffer from Alopecia Universalis, Alopecia Totalis, Active Trichotillomania (hair pulling)?

List all active and inactive medical conditions:

List all prescription medications, over-the-counter medications, vitamins, herbs and supplements you routinely take:

Have you ever suffered from or have been treated for substance abuse or dependence? Explain.

List all previous surgical procedures:

Can you provide your own transportation to and from Dr. Bauman's clinic in Jacksonville, Florida on the day of your procedure (you will not be allowed to drive yourself)?

Can you provide your own local accommodations in Jacksonville, Florida
(if applicable)?

What is your current eyelash status? Why are you interested in the eyelash transplant procedure?

Are you able to provide three photos: 1) full face, 2) upper face close-up, 3) back of head if you are selected for the free procedure?

Your full name - privacy protected

Address - privacy protected

Telephone number - privacy protected

Email address - privacy protected

PRIVACY PROTECTED
Information will only be used by Bauman Medical for selecting the right candidates for the
free eyelash transplant procedure. We do not sell or share your information with third parties.

Any questions, please email HairSite@aol.com

Sponsors
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