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Thank you, Please fill in our medical questionairre

Thank you for enquiring with Ashley and Martin. To enable us to organise your remote consultation, please fill in the medical questionnaire form below, this questionnaire is important so that our consultant and doctor can make the most accurate diagnosis and treatment recommendations.
Once your medical questionnaire has been submitted one of our consultants from our Medical Hair Centre for regional areas (remote consultations) will call you to set an appointment for a time and day convenient to you for the Skype consultation. If you do not already have Skype setup on your phone, please do so well before the consultation time, you can download the apps here. Ashley and Martin’s Skype name is “goldcoastclinic”, add us to your Skype contacts.
Medical Questionnaire for Women
Ashley and Martin's Skype name is "goldcoastclinic", add us to your Skype contacts.