Zamów darmową konsultację

Contact info

First name

Last name

Phone

E-mail address

Prefer contact

Preferred contact hours

Where you have find out about MedHair?

Information about the transplant type

Sex

Transplant method

Additional information (optional)

Photos

The quality of photos is important to precisely evaluate transplant needs. Could you please send photos from the distance not exceeding 50cm from the head with particular focus on back of the head (donor area).

In case you shave this area, please send photos with at least 2 weeks hair growth. Thank You.

Consent for processing of the personal data

We inform you, that the personal data sent via this online form is administrated by M.H. Paweł Urbański (hereinafter reffered to as „MedHair”) located in Szczecin 70-542, Sienna 3, VAT No 8521294304. All inquiries can be sent to data administrator e-mail: info@medhair.pl. All the data will processed only regarding the transplant inquiry, according to the directive that states „the processing of personal data is lawful if it’s necessary for the performance of contract or before concluding the contract”. Consent for marketing option results in processing the personal data also for sending advertising and marketing. Full information about the Personal Data Processing Policy is available in Information Obligation link

I confirm I have read the Information Obligation document and I agree for processing my personal data by Medhair for the purpose of further correspondence regarding my inquiry (this field is necessary to complete the inquiry)

I hereby agree for processing my personal data for the purpose of sending me commercial content on the e-mail address I have submitted in the contact form. (optional)

We inform you, that your consent can be canceled any time by sending message to the personal data administrator: info@medhair.pl form e-mail address which was used to make the consent.

Contact form