{"id":313,"date":"2023-02-08T20:28:14","date_gmt":"2023-02-08T20:28:14","guid":{"rendered":"https:\/\/elanclinic.co.uk\/lp\/?page_id=313"},"modified":"2025-02-28T09:12:18","modified_gmt":"2025-02-28T09:12:18","slug":"colibri-313","status":"publish","type":"page","link":"https:\/\/elanclinic.co.uk\/index.php\/colibri-313\/","title":{"rendered":"Consultation Form"},"content":{"rendered":"<div data-colibri-id=\"313-c1\" class=\"style-374 style-local-313-c1 position-relative\">\n  <!---->\n  <div data-colibri-component=\"section\" data-colibri-id=\"313-c2\" id=\"about\" class=\"h-section h-section-global-spacing d-flex align-items-lg-center align-items-md-center align-items-center style-375 style-local-313-c2 position-relative\">\n    <!---->\n    <!---->\n    <div class=\"h-section-grid-container h-section-boxed-container\">\n      <!---->\n      <div data-colibri-id=\"313-c3\" class=\"h-row-container gutters-row-lg-2 gutters-row-md-2 gutters-row-2 gutters-row-v-lg-2 gutters-row-v-md-2 gutters-row-v-2 style-376 style-local-313-c3 position-relative\">\n        <!---->\n        <div class=\"h-row justify-content-lg-center justify-content-md-center justify-content-center align-items-lg-stretch align-items-md-stretch align-items-stretch gutters-col-lg-2 gutters-col-md-2 gutters-col-2 gutters-col-v-lg-2 gutters-col-v-md-2 gutters-col-v-2\">\n          <!---->\n          <div class=\"h-column h-column-container d-flex h-col-lg-auto h-col-md-auto h-col-auto style-377-outer style-local-313-c4-outer\">\n            <div data-colibri-id=\"313-c4\" class=\"d-flex h-flex-basis h-column__inner h-px-lg-2 h-px-md-2 h-px-2 v-inner-lg-2 v-inner-md-2 v-inner-2 style-377 style-local-313-c4 position-relative\">\n              <!---->\n              <!---->\n              <div class=\"w-100 h-y-container h-column__content h-column__v-align flex-basis-100 align-self-lg-center align-self-md-center align-self-center\">\n                <!---->\n                <div data-colibri-id=\"313-c5\" class=\"h-global-transition-all h-heading style-378 style-local-313-c5 position-relative h-element\">\n                  <!---->\n                  <div class=\"h-heading__outer style-378 style-local-313-c5\">\n                    <!---->\n                    <!---->\n                    <h5 class=\"\">CONSULTATION FORM<\/h5>\n                  <\/div>\n                <\/div>\n                <div data-colibri-id=\"313-c6\" class=\"h-global-transition-all h-heading style-379 style-local-313-c6 position-relative h-element\">\n                  <!---->\n                  <div class=\"h-heading__outer style-379 style-local-313-c6\">\n                    <!---->\n                    <!---->\n                    <h2 class=\"\">Please complete the&nbsp;<em style=\"font-family: &quot;Playfair Display&quot;; color: rgb(3, 169, 244);\">consultation form<\/em>&nbsp;for your no obligation appraisal<\/h2>\n                  <\/div>\n                <\/div>\n                <div data-colibri-id=\"313-c7\" class=\"h-lead h-text h-text-component style-380 style-local-313-c7 position-relative h-element\">\n                  <!---->\n                  <!---->\n                  <div class=\"\">\n                    <p>Every case of hair loss is different, and while we strive to help as many people as possible, suitability varies. By completing this form, we can assess whether a one-to-one consultation may be right for you.<\/p>\n                  <\/div>\n                <\/div>\n              <\/div>\n            <\/div>\n          <\/div>\n          <div class=\"h-column h-column-container d-flex h-col-lg-auto h-col-md-auto h-col-auto style-383-outer style-local-313-c8-outer\">\n            <div data-colibri-id=\"313-c8\" class=\"d-flex h-flex-basis h-column__inner h-px-lg-2 h-px-md-2 h-px-2 v-inner-lg-2 v-inner-md-2 v-inner-2 style-383 style-local-313-c8 position-relative\">\n              <!---->\n              <!---->\n              <div class=\"w-100 h-y-container h-column__content h-column__v-align flex-basis-100 align-self-lg-center align-self-md-center align-self-center\">\n                <!---->\n                <div data-colibri-id=\"313-c9\" class=\"d-block style-384 style-local-313-c9 position-relative h-element\">\n                  <!---->\n                  <div class=\"h-image__frame-container-outer\">\n                    <div class=\"h-image__frame-container\">\n                      <!---->\n                      <!---->\n                      <img loading=\"lazy\" decoding=\"async\" width=\"1399\" height=\"1403\" src=\"https:\/\/elanclinic.co.uk\/lp\/wp-content\/uploads\/2022\/10\/cropped-cropped-Screen-Shot-2022-10-30-at-10.33.36-scaled-1.jpg\" class=\"wp-image-368 style-384-image style-local-313-c9-image\" alt=\"\" srcset=\"https:\/\/elanclinic.co.uk\/wp-content\/uploads\/2022\/10\/cropped-cropped-Screen-Shot-2022-10-30-at-10.33.36-scaled-1.jpg 1399w, https:\/\/elanclinic.co.uk\/wp-content\/uploads\/2022\/10\/cropped-cropped-Screen-Shot-2022-10-30-at-10.33.36-scaled-1-300x300.jpg 300w, https:\/\/elanclinic.co.uk\/wp-content\/uploads\/2022\/10\/cropped-cropped-Screen-Shot-2022-10-30-at-10.33.36-scaled-1-1021x1024.jpg 1021w, https:\/\/elanclinic.co.uk\/wp-content\/uploads\/2022\/10\/cropped-cropped-Screen-Shot-2022-10-30-at-10.33.36-scaled-1-150x150.jpg 150w, https:\/\/elanclinic.co.uk\/wp-content\/uploads\/2022\/10\/cropped-cropped-Screen-Shot-2022-10-30-at-10.33.36-scaled-1-768x770.jpg 768w\" sizes=\"auto, (max-width: 1399px) 100vw, 1399px\" \/>\n                      <div class=\"h-image__frame h-hide-sm style-384-frameImage style-local-313-c9-frameImage\"><\/div>\n                    <\/div>\n                  <\/div>\n                <\/div>\n              <\/div>\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/div>\n    <\/div>\n  <\/div>\n  <div data-colibri-component=\"section\" data-colibri-id=\"313-c10\" id=\"custom\" class=\"h-section h-section-global-spacing d-flex align-items-lg-center align-items-md-center align-items-center style-394 style-local-313-c10 position-relative\">\n    <!---->\n    <!---->\n    <div class=\"h-section-grid-container h-section-boxed-container\">\n      <!---->\n      <div data-colibri-id=\"313-c11\" class=\"h-row-container gutters-row-lg-2 gutters-row-md-2 gutters-row-0 gutters-row-v-lg-2 gutters-row-v-md-2 gutters-row-v-2 style-395 style-local-313-c11 position-relative\">\n        <!---->\n        <div class=\"h-row justify-content-lg-center justify-content-md-center justify-content-center align-items-lg-stretch align-items-md-stretch align-items-stretch gutters-col-lg-2 gutters-col-md-2 gutters-col-0 gutters-col-v-lg-2 gutters-col-v-md-2 gutters-col-v-2\">\n          <!---->\n          <div class=\"h-column h-column-container d-flex h-col-lg-auto h-col-md-auto h-col-auto style-396-outer style-local-313-c12-outer\">\n            <div data-colibri-id=\"313-c12\" class=\"d-flex h-flex-basis h-column__inner h-px-lg-2 h-px-md-2 h-px-2 v-inner-lg-2 v-inner-md-2 v-inner-2 style-396 style-local-313-c12 position-relative\">\n              <!---->\n              <!---->\n              <div class=\"w-100 h-y-container h-column__content h-column__v-align flex-basis-100 align-self-lg-start align-self-md-start align-self-start\">\n                <!---->\n                <div data-colibri-id=\"313-c13\" class=\"h-text h-text-component style-397 style-local-313-c13 position-relative h-element\">\n                  <!---->\n                  <!---->\n                  <div class=\"\">\n                    <div class=\"forminator-ui forminator-custom-form forminator-custom-form-298 forminator-design--default forminator-enclosed forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-298\" data-uid=\"69e8f1ddb6ad0\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-298\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-298 forminator-design--default forminator-enclosed forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"298\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"enclosed\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69e8f1ddb6ad0\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_69e8f1ddb6ad0\" id=\"forminator-field-name-1_69e8f1ddb6ad0-label\" class=\"forminator-label\">Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-1_69e8f1ddb6ad0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-298__field--select-1_69e8f1ddb6ad0\" id=\"forminator-form-298__field--select-1_69e8f1ddb6ad0-label\" class=\"forminator-label\">Is your hair thinning\/shedding? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-298__field--select-1_69e8f1ddb6ad0\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-1\" data-default-value=\"\" data-placeholder=\"Is your hair thinning\/shedding?\" data-search=\"false\" data-search-placeholder=\"Is your hair thinning\/shedding?\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-298__field--select-1_69e8f1ddb6ad0-label\"><option value=\"\"  >Is your hair thinning\/shedding?<\/option><option value=\"one\"  data-calculation=\"0\">Yes<\/option><option value=\"two\"  data-calculation=\"0\">No<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-298__field--select-2_69e8f1ddb6ad0\" id=\"forminator-form-298__field--select-2_69e8f1ddb6ad0-label\" class=\"forminator-label\">Have you experienced hair loss before? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-298__field--select-2_69e8f1ddb6ad0\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-2\" data-default-value=\"\" data-placeholder=\"Have you experienced hair loss before?\" data-search=\"false\" data-search-placeholder=\"Have you experienced hair loss before?\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-298__field--select-2_69e8f1ddb6ad0-label\"><option value=\"\"  >Have you experienced hair loss before?<\/option><option value=\"one\"  data-calculation=\"0\">Yes<\/option><option value=\"two\"  data-calculation=\"0\">No<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-298__field--select-3_69e8f1ddb6ad0\" id=\"forminator-form-298__field--select-3_69e8f1ddb6ad0-label\" class=\"forminator-label\">How long have you been experiencing hair loss? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-298__field--select-3_69e8f1ddb6ad0\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-3\" data-default-value=\"\" data-placeholder=\"How long have you been experiencing hair loss?\" data-search=\"false\" data-search-placeholder=\"How long have you been experiencing hair loss?\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-298__field--select-3_69e8f1ddb6ad0-label\"><option value=\"\"  >How long have you been experiencing hair loss?<\/option><option value=\"one\"  data-calculation=\"0\">Less than a month<\/option><option value=\"two\"  data-calculation=\"0\">1 to 3 months<\/option><option value=\"3-to-6-months\"  data-calculation=\"0\">3 to 6 months<\/option><option value=\"more-than-6-months\"  data-calculation=\"0\">more than 6 months<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-298__field--select-4_69e8f1ddb6ad0\" id=\"forminator-form-298__field--select-4_69e8f1ddb6ad0-label\" class=\"forminator-label\">Do you experience hair loss elsewhere on the body? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-298__field--select-4_69e8f1ddb6ad0\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-4\" data-default-value=\"\" data-placeholder=\"Do you experience hair loss elsewhere on the body?\" data-search=\"false\" data-search-placeholder=\"Do you experience hair loss elsewhere on the body?\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-298__field--select-4_69e8f1ddb6ad0-label\"><option value=\"\"  >Do you experience hair loss elsewhere on the body?<\/option><option value=\"one\"  data-calculation=\"0\">Yes<\/option><option value=\"two\"  data-calculation=\"0\">No<\/option><option value=\"Haven&#039;t-noticed\"  data-calculation=\"0\">Haven't noticed<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-5\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-298__field--select-5_69e8f1ddb6ad0\" id=\"forminator-form-298__field--select-5_69e8f1ddb6ad0-label\" class=\"forminator-label\">Does you hair easily break\/snap? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-298__field--select-5_69e8f1ddb6ad0\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-5\" data-default-value=\"\" data-placeholder=\"Does you hair easily break\/snap?\" data-search=\"false\" data-search-placeholder=\"Does you hair easily break\/snap?\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-298__field--select-5_69e8f1ddb6ad0-label\"><option value=\"\"  >Does you hair easily break\/snap?<\/option><option value=\"one\"  data-calculation=\"0\">Yes<\/option><option value=\"two\"  data-calculation=\"0\">No<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-6\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-298__field--select-6_69e8f1ddb6ad0\" id=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-label\" class=\"forminator-label\">Is your scalp:<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-label\" aria-describedby=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-description\"><label id=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-1-label\" for=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"one\" id=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-1\" aria-labelledby=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-1-label\" data-calculation=\"0\"   \/>Itchy<\/label><label id=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-2-label\" for=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"two\" id=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-2\" aria-labelledby=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-2-label\" data-calculation=\"0\"   \/>Flakey\/scaling<\/label><label id=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-3-label\" for=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-3\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-6[]\" value=\"N-A\" id=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-3\" aria-labelledby=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-3-label\" data-calculation=\"0\"   \/>N\/A<\/label><input type='hidden' name='select-6-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><span id=\"forminator-form-298__field--select-6_69e8f1ddb6ad0-description\" class=\"forminator-description\">select one or multiple<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-7\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-298__field--select-7_69e8f1ddb6ad0\" id=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-label\" class=\"forminator-label\">Are you currently:<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-label\" aria-describedby=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-description\"><label id=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-1-label\" for=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"one\" id=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-1\" aria-labelledby=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-1-label\" data-calculation=\"0\"   \/>Receiving any medical treatment?<\/label><label id=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-2-label\" for=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"two\" id=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-2\" aria-labelledby=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-2-label\" data-calculation=\"0\"   \/>Taking any medication (last 5 years)?<\/label><label id=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-3-label\" for=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-3\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"Taking-a-contraceptive-pill-or-hormone-replacement-therapy-anabolic-steroids?\" id=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-3\" aria-labelledby=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-3-label\" data-calculation=\"0\"   \/>Taking a contraceptive pill or hormone replacement therapy\/anabolic steroids?<\/label><label id=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-4-label\" for=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-4\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-7[]\" value=\"N-A\" id=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-4\" aria-labelledby=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-4-label\" data-calculation=\"0\"   \/>N\/A<\/label><input type='hidden' name='select-7-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><span id=\"forminator-form-298__field--select-7_69e8f1ddb6ad0-description\" class=\"forminator-description\">Optional<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-8\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-298__field--select-8_69e8f1ddb6ad0\" id=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-label\" class=\"forminator-label\">Have you recently undergone any kind of:<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-label\" aria-describedby=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-description\"><label id=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-1-label\" for=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"one\" id=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-1\" aria-labelledby=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-1-label\" data-calculation=\"0\"   \/>Surgery<\/label><label id=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-2-label\" for=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"two\" id=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-2\" aria-labelledby=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-2-label\" data-calculation=\"0\"   \/>Accidents causing physical harm<\/label><label id=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-3-label\" for=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-3\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"Periods-of-stress\" id=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-3\" aria-labelledby=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-3-label\" data-calculation=\"0\"   \/>Periods of stress<\/label><label id=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-4-label\" for=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-4\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-8[]\" value=\"N-A\" id=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-4\" aria-labelledby=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-4-label\" data-calculation=\"0\"   \/>N\/A<\/label><input type='hidden' name='select-8-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><span id=\"forminator-form-298__field--select-8_69e8f1ddb6ad0-description\" class=\"forminator-description\">enter one or multiple<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69e8f1ddb6ad0\" id=\"forminator-field-email-1_69e8f1ddb6ad0-label\" class=\"forminator-label\">Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E.g. john@doe.com\" id=\"forminator-field-email-1_69e8f1ddb6ad0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69e8f1ddb6ad0\" id=\"forminator-field-phone-1_69e8f1ddb6ad0-label\" class=\"forminator-label\">Phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.g. 07000 000 000\" id=\"forminator-field-phone-1_69e8f1ddb6ad0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" maxlength=\"11\" data-validation=\"character_limit\" \/><span id=\"forminator-field-phone-1_69e8f1ddb6ad0-description\" class=\"forminator-description\" id=\"forminator-field-phone-1_69e8f1ddb6ad0-description\"><span data-limit=\"11\" data-type=\"\">0 \/ 11<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_69e8f1ddb6ad0\" id=\"forminator-field-consent-1_69e8f1ddb6ad0-label\" class=\"forminator-label\">Consent <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_69e8f1ddb6ad0__label\" class=\"forminator-checkbox forminator-consent\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_69e8f1ddb6ad0\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_69e8f1ddb6ad0-label\" aria-describedby=\"forminator-field-consent-1_69e8f1ddb6ad0__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_69e8f1ddb6ad0__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>I agree to be contacted &nbsp;regarding my no obligation appraisal of whether I would be suitable for a consultation. Your data will not be shared with anybody else beyond ourselves and will only be used to determine if we may be able to help you.<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_69e8f1ddb6ad0\" id=\"forminator-field-textarea-1_69e8f1ddb6ad0-label\" class=\"forminator-label\">Further Notes<\/label><textarea name=\"textarea-1\" placeholder=\"Enter any further note that you wish here\" id=\"forminator-field-textarea-1_69e8f1ddb6ad0\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Send Message<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"fcf6926cf7\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/313\" \/><input type=\"hidden\" name=\"form_id\" value=\"298\"><input type=\"hidden\" name=\"page_id\" value=\"313\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/elanclinic.co.uk\/index.php\/colibri-313\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>\n                  <\/div>\n                <\/div>\n              <\/div>\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/div>\n    <\/div>\n  <\/div>\n  <div data-colibri-component=\"section\" data-colibri-id=\"313-c14\" id=\"custom-2\" class=\"h-section h-section-global-spacing d-flex align-items-lg-center align-items-md-center align-items-center style-1573 style-local-313-c14 position-relative\">\n    <!---->\n    <!---->\n    <div class=\"h-section-grid-container h-section-boxed-container\">\n      <!---->\n      <div data-colibri-id=\"313-c15\" class=\"h-row-container gutters-row-lg-2 gutters-row-md-2 gutters-row-0 gutters-row-v-lg-2 gutters-row-v-md-2 gutters-row-v-2 style-1576 style-local-313-c15 position-relative\">\n        <!---->\n        <div class=\"h-row justify-content-lg-center justify-content-md-center justify-content-center align-items-lg-stretch align-items-md-stretch align-items-stretch gutters-col-lg-2 gutters-col-md-2 gutters-col-0 gutters-col-v-lg-2 gutters-col-v-md-2 gutters-col-v-2\">\n          <!---->\n          <div class=\"h-column h-column-container d-flex h-col-lg-auto h-col-md-auto h-col-auto style-1577-outer style-local-313-c16-outer\">\n            <div data-colibri-id=\"313-c16\" class=\"d-flex h-flex-basis h-column__inner h-px-lg-2 h-px-md-2 h-px-2 v-inner-lg-2 v-inner-md-2 v-inner-2 style-1577 style-local-313-c16 position-relative\">\n              <!---->\n              <!---->\n              <div class=\"w-100 h-y-container h-column__content h-column__v-align flex-basis-100 align-self-lg-start align-self-md-start align-self-start\">\n                <!---->\n                <div data-colibri-id=\"313-c17\" class=\"h-text h-text-component style-1578 style-local-313-c17 position-relative h-element\">\n                  <!---->\n                  <!---->\n                  <div class=\"\">\n                    <p>Our consultation appointments are \u00a3217<\/p>\n                    <p>This is inclusive of :-<\/p>\n                    <p>G.P referral letters for an up to date blood test.<\/p>\n                    <p>One to one consultation and examination at our clinic in Stratford upon Avon including<\/p>\n                    <p>Trichoscopy, the highly magnified pictures of your scalp &amp; hair follicles with a very detailed report to follow in 4 days.<\/p>\n                    <p>Full research of consultation forms and your timeline.<\/p>\n                    <p>Microscopy evaluation. This is the study of your hair under our clinical grade microscope. A detailed report will follow in 4 working days. <\/p>\n                    <p>\n                      <br>\n                    <\/p>\n                  <\/div>\n                <\/div>\n              <\/div>\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/div>\n    <\/div>\n  <\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>CONSULTATION FORM Please complete the&nbsp;consultation form&nbsp;for your no obligation appraisal Every case of hair loss is different, and while we strive to help as many people as possible, suitability varies. By completing this form, we can assess whether a one-to-one consultation may be right for you. Our consultation appointments are \u00a3217 This is inclusive of [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/full-width-page.php","meta":{"_joinchat":[],"footnotes":""},"class_list":["post-313","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Consultation Form - Elan Clinic - Hair Loss Treatment<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/elanclinic.co.uk\/index.php\/colibri-313\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Consultation Form - Elan Clinic - Hair Loss Treatment\" \/>\n<meta property=\"og:description\" content=\"CONSULTATION FORM Please complete the&nbsp;consultation form&nbsp;for your no obligation appraisal Every case of hair loss is different, and while we strive to help as many people as possible, suitability varies. By completing this form, we can assess whether a one-to-one consultation may be right for you. Our consultation appointments are \u00a3217 This is inclusive of [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/elanclinic.co.uk\/index.php\/colibri-313\/\" \/>\n<meta property=\"og:site_name\" content=\"Elan Clinic - Hair Loss Treatment\" \/>\n<meta property=\"article:modified_time\" content=\"2025-02-28T09:12:18+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/elanclinic.co.uk\/wp-content\/uploads\/2022\/10\/cropped-cropped-Screen-Shot-2022-10-30-at-10.33.36-scaled-1.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1399\" \/>\n\t<meta property=\"og:image:height\" content=\"1403\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/elanclinic.co.uk\\\/index.php\\\/colibri-313\\\/\",\"url\":\"https:\\\/\\\/elanclinic.co.uk\\\/index.php\\\/colibri-313\\\/\",\"name\":\"Consultation Form - Elan Clinic - Hair Loss Treatment\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/elanclinic.co.uk\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/elanclinic.co.uk\\\/index.php\\\/colibri-313\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/elanclinic.co.uk\\\/index.php\\\/colibri-313\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/elanclinic.co.uk\\\/lp\\\/wp-content\\\/uploads\\\/2022\\\/10\\\/cropped-cropped-Screen-Shot-2022-10-30-at-10.33.36-scaled-1.jpg\",\"datePublished\":\"2023-02-08T20:28:14+00:00\",\"dateModified\":\"2025-02-28T09:12:18+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/elanclinic.co.uk\\\/index.php\\\/colibri-313\\\/#breadcrumb\"},\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/elanclinic.co.uk\\\/index.php\\\/colibri-313\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\\\/\\\/elanclinic.co.uk\\\/index.php\\\/colibri-313\\\/#primaryimage\",\"url\":\"https:\\\/\\\/elanclinic.co.uk\\\/wp-content\\\/uploads\\\/2022\\\/10\\\/cropped-cropped-Screen-Shot-2022-10-30-at-10.33.36-scaled-1.jpg\",\"contentUrl\":\"https:\\\/\\\/elanclinic.co.uk\\\/wp-content\\\/uploads\\\/2022\\\/10\\\/cropped-cropped-Screen-Shot-2022-10-30-at-10.33.36-scaled-1.jpg\",\"width\":1399,\"height\":1403},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/elanclinic.co.uk\\\/index.php\\\/colibri-313\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/elanclinic.co.uk\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Consultation Form\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/elanclinic.co.uk\\\/#website\",\"url\":\"https:\\\/\\\/elanclinic.co.uk\\\/\",\"name\":\"Elan Clinic - Hair Loss Treatment\",\"description\":\"We want to help\",\"publisher\":{\"@id\":\"https:\\\/\\\/elanclinic.co.uk\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/elanclinic.co.uk\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-GB\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/elanclinic.co.uk\\\/#organization\",\"name\":\"Elan Clinic - Hair Loss Treatment\",\"url\":\"https:\\\/\\\/elanclinic.co.uk\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\\\/\\\/elanclinic.co.uk\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/elanclinic.co.uk\\\/wp-content\\\/uploads\\\/2023\\\/10\\\/elan-thin.png\",\"contentUrl\":\"https:\\\/\\\/elanclinic.co.uk\\\/wp-content\\\/uploads\\\/2023\\\/10\\\/elan-thin.png\",\"width\":230,\"height\":99,\"caption\":\"Elan Clinic - Hair Loss Treatment\"},\"image\":{\"@id\":\"https:\\\/\\\/elanclinic.co.uk\\\/#\\\/schema\\\/logo\\\/image\\\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Consultation Form - Elan Clinic - Hair Loss Treatment","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/elanclinic.co.uk\/index.php\/colibri-313\/","og_locale":"en_GB","og_type":"article","og_title":"Consultation Form - Elan Clinic - Hair Loss Treatment","og_description":"CONSULTATION FORM Please complete the&nbsp;consultation form&nbsp;for your no obligation appraisal Every case of hair loss is different, and while we strive to help as many people as possible, suitability varies. By completing this form, we can assess whether a one-to-one consultation may be right for you. Our consultation appointments are \u00a3217 This is inclusive of [&hellip;]","og_url":"https:\/\/elanclinic.co.uk\/index.php\/colibri-313\/","og_site_name":"Elan Clinic - Hair Loss Treatment","article_modified_time":"2025-02-28T09:12:18+00:00","og_image":[{"width":1399,"height":1403,"url":"https:\/\/elanclinic.co.uk\/wp-content\/uploads\/2022\/10\/cropped-cropped-Screen-Shot-2022-10-30-at-10.33.36-scaled-1.jpg","type":"image\/jpeg"}],"twitter_card":"summary_large_image","twitter_misc":{"Estimated reading time":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/elanclinic.co.uk\/index.php\/colibri-313\/","url":"https:\/\/elanclinic.co.uk\/index.php\/colibri-313\/","name":"Consultation Form - Elan Clinic - Hair Loss Treatment","isPartOf":{"@id":"https:\/\/elanclinic.co.uk\/#website"},"primaryImageOfPage":{"@id":"https:\/\/elanclinic.co.uk\/index.php\/colibri-313\/#primaryimage"},"image":{"@id":"https:\/\/elanclinic.co.uk\/index.php\/colibri-313\/#primaryimage"},"thumbnailUrl":"https:\/\/elanclinic.co.uk\/lp\/wp-content\/uploads\/2022\/10\/cropped-cropped-Screen-Shot-2022-10-30-at-10.33.36-scaled-1.jpg","datePublished":"2023-02-08T20:28:14+00:00","dateModified":"2025-02-28T09:12:18+00:00","breadcrumb":{"@id":"https:\/\/elanclinic.co.uk\/index.php\/colibri-313\/#breadcrumb"},"inLanguage":"en-GB","potentialAction":[{"@type":"ReadAction","target":["https:\/\/elanclinic.co.uk\/index.php\/colibri-313\/"]}]},{"@type":"ImageObject","inLanguage":"en-GB","@id":"https:\/\/elanclinic.co.uk\/index.php\/colibri-313\/#primaryimage","url":"https:\/\/elanclinic.co.uk\/wp-content\/uploads\/2022\/10\/cropped-cropped-Screen-Shot-2022-10-30-at-10.33.36-scaled-1.jpg","contentUrl":"https:\/\/elanclinic.co.uk\/wp-content\/uploads\/2022\/10\/cropped-cropped-Screen-Shot-2022-10-30-at-10.33.36-scaled-1.jpg","width":1399,"height":1403},{"@type":"BreadcrumbList","@id":"https:\/\/elanclinic.co.uk\/index.php\/colibri-313\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/elanclinic.co.uk\/"},{"@type":"ListItem","position":2,"name":"Consultation Form"}]},{"@type":"WebSite","@id":"https:\/\/elanclinic.co.uk\/#website","url":"https:\/\/elanclinic.co.uk\/","name":"Elan Clinic - Hair Loss Treatment","description":"We want to help","publisher":{"@id":"https:\/\/elanclinic.co.uk\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/elanclinic.co.uk\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-GB"},{"@type":"Organization","@id":"https:\/\/elanclinic.co.uk\/#organization","name":"Elan Clinic - Hair Loss Treatment","url":"https:\/\/elanclinic.co.uk\/","logo":{"@type":"ImageObject","inLanguage":"en-GB","@id":"https:\/\/elanclinic.co.uk\/#\/schema\/logo\/image\/","url":"https:\/\/elanclinic.co.uk\/wp-content\/uploads\/2023\/10\/elan-thin.png","contentUrl":"https:\/\/elanclinic.co.uk\/wp-content\/uploads\/2023\/10\/elan-thin.png","width":230,"height":99,"caption":"Elan Clinic - Hair Loss Treatment"},"image":{"@id":"https:\/\/elanclinic.co.uk\/#\/schema\/logo\/image\/"}}]}},"_links":{"self":[{"href":"https:\/\/elanclinic.co.uk\/index.php\/wp-json\/wp\/v2\/pages\/313","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/elanclinic.co.uk\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/elanclinic.co.uk\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/elanclinic.co.uk\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/elanclinic.co.uk\/index.php\/wp-json\/wp\/v2\/comments?post=313"}],"version-history":[{"count":12,"href":"https:\/\/elanclinic.co.uk\/index.php\/wp-json\/wp\/v2\/pages\/313\/revisions"}],"predecessor-version":[{"id":1960,"href":"https:\/\/elanclinic.co.uk\/index.php\/wp-json\/wp\/v2\/pages\/313\/revisions\/1960"}],"wp:attachment":[{"href":"https:\/\/elanclinic.co.uk\/index.php\/wp-json\/wp\/v2\/media?parent=313"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}