Script Request

Submitting this form does not guarantee that a prescription will be issued. A Medical Hair Restoration doctor will review your information and determine suitability based on your clinical profile.

First Name

Last Name

Email

Phone

Are you male or female?
MaleFemale

How old are you?

Are you pregnant, trying to become pregnant or breast feeding?
YesNo

Do you have a history of heart disease?
YesNo

Are you allergic to any medication?
YesNo

Are you taking blood pressure medication?
YesNo

Do you have any significant medical history (any medical or surgical conditions that we should know about)?
YesNo

Patient Medications: Please list all medication you are currently using.

Medication you are interested in: Please let us know which medication you are interested in.

Comment or message (optional)

Upload a photo of your hair (optional)

9 Somerset Road, de Waterkant Center, Green Point, Cape Town, 8000

Phone: +27 21 425 77 55

Email: info@medhairdrjankelowitz.co.za

Web: www.medhairdrjankelowitz.co.za

Show Medical Hair Restoration On Google Maps

      Excellent rating  
 Based on 159 reviews 
    
  
 
 
      Trustindex verifies that the original source of the review is Google. I have dealt with you for a number of months and it has been a delight. A huge gratitude goes out to Glenda Patel who's forever smilling through the phone. What a fresh breath of customer service she offers. Speedy on delivery feedback and always making sure to give extra calls to confirm the details. Love the OTT, effort and energy put in the package and your product is one of thee best in the market and cost efficient.
     
   Musa Mogane 
 
 
 
 
 
    Trustindex verifies that the original source of the review is Google. Awesome experience. Amazing staff
     
   Jacques Aucamp 
 
 
 
 
 
    Trustindex verifies that the original source of the review is Google. Overall, I had a positive experience with MHR. The team was professional and helpful, and I appreciate the follow-up and support throughout the process. One section of the FUT incision did take longer to heal than expected, but I really appreciated that Dr Ryan was always willing to assist and provide guidance after the procedure while I was struggling with the healing of the incision.
     
   Willem van Zyl 
 
 
 
 
 
    Trustindex verifies that the original source of the review is Google. By far the best service received from MHR, Dr Ryan and the team really took their time to understand my needs and made me feel at easy from the moment I step foot in their door, Thank you guys once again!!
     
   Faizel Holliday