Hair and Scalp Clinic of Indianapolis

Hair & Scalp
Clinic of Indianapolis

The Hair & Scalp Clinic of Indianapolis has helped countless thousands in the Midwest for over 30 years, and now is available to all on the Internet as well. We have been a member of the Better Business Bureau since 1963, and are licensed by the State Board of Cosmetology.

All Tryko Hair and Scalp
Products

Dermaplex Shampoo, Debreen Scalp Cleanser, Zephraderm

A Member of the Better
Business Bureau since 1963

Free Consultation

To receive your personalized Free Consultation (a special offer for our Internet clients), please complete the questionaire and click the "SUBMIT" button. We may contact you for additional information if necessary. Otherwise, you will receive our detailed consultation and professional suggestions along with our trial offer with limited money back guarantee. You may also contact us personally by email at wrwellman@comcast.net.

Your Name:
Address:
City:
State:
Zip:
E-mail:
Phone Number:

Age:
Race:
Sex:

Type of Hair:
How long has your hair been thinning:
Hair fall recently:
Scalp Condition - A:
Scalp Condition - B:
Any indication of scalp disease:
Open abrasions on scalp:
Family history of baldness or thinning:

General Health:
Under doctor's care at present:
Serious illness:
Prescription medications:
Diet:
Stress level:
Exercise regularly:
Do you take vitamins regularly:
	Type:

How often do you shampoo:
Do you use conditioner:
Do you:
Do you use dressings, hair spray, mousse, gel, oil, grease, etc.:
	Frequency:
Any chemicals used, such as perms, dyes, bleach, relaxer, curl, etc.:
	Frequency:
Do you wear wigs, hats, night cover, etc.:
	Frequency:

Please describe your problem briefly:
Other comments:

Visit our Clinic

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Hair & Scalp Clinic of Indianapolis
9135 N. Meridian St.
Suite C-3
Indianapolis, IN 46260

Hair & Scalp Clinic of Indianapolis

All Tryko Hair and Scalp Products

Dermaplex Shampoo, Debreen Scalp Cleanser, Zephraderm

A Member of the Better Business Bureau since 1963

Free Consultation

Hair & Scalp
Clinic of Indianapolis

All Tryko Hair and Scalp
Products

A Member of the Better
Business Bureau since 1963