Online Consultation - The Hair Loss Center - Dr Bernard Cohen - Transplantation - Restoration - Removal - Replacement

<% @LANGUAGE=VBSCRIPT %> <% Response.Buffer = True Response.Expires = -10000 %> <% Dim sError If Len(Trim(Request.Form("btnSubmit"))) <> 0 Then If Len(Trim(Request.Form("txtName"))) = 0 Then sError = "Please Enter a Name" ElseIf Len(Trim(Request.Form("txtEmail"))) = 0 Then sError = "Please provide an Email Address" End If End If If Len(Trim(sError)) = 0 AND Len(Trim(Request.Form("btnSubmit"))) <> 0 Then Dim sName, sEmail, sPhone Dim sForeCM, sForeIn, s5VCM, s5VIN, s4CM, s4IN Dim sZ1, sZ2, sZ3, sZ4, sZ5, sZ6, sZ7, sZ8, sZ9, sZ10 sName = Trim(Request.Form("txtName")) sEmail = Trim(Request.Form("txtEmail")) sPhone = Trim(Request.Form("txtPhone")) sForeCM = Trim(Request.Form("txt_fore_cm")) sForeIn = Trim(Request.Form("txt_fore_in")) s5VCM = Trim(Request.Form("txt5V_cm")) s5VIN = Trim(Request.Form("txt5V_in")) s4CM = Trim(Request.Form("txt4_cm")) s4IN = Trim(Request.Form("txt4_in")) sZ1 = Trim(Request.Form("rad_Z1")) sZ2 = Trim(Request.Form("rad_Z2")) sZ3 = Trim(Request.Form("rad_Z3")) sZ4 = Trim(Request.Form("rad_Z4")) sZ5 = Trim(Request.Form("rad_Z5")) sZ6 = Trim(Request.Form("rad_Z6")) sZ7 = Trim(Request.Form("rad_Z7")) sZ8 = Trim(Request.Form("rad_Z8")) sZ9 = Trim(Request.Form("rad_Z9")) sz10 = Trim(Request.Form("rad_Z10")) Dim sTmp sTmp = "Please do not respond to this e-mail. This is an unmonitored account." & vbCrLf sTmp = sTmp & "_______________________________________________________________________" & vbCrLf & vbCrLf sTmp = sTmp & "Contact Information" & vbCrLf sTmp = sTmp & "Name: " & sName & vbCrLf sTmp = sTmp & "Phone: " & sPhone & vbCrLf sTmp = sTmp & "Email: " & sEmail & vbCrLf & vbCrLf sTmp = sTmp & "Measurements " & vbCrLf sTmp = sTmp & "FOREHEAD: " & sForeCM & "cm" & sForeIN & "in" & vbCrLF sTmp = sTmp & "5V: " & s5VCM & "cm" & s5VIN & "in" & vbCrLF sTmp = sTmp & "4: " & s4CM & "cm" & s4IN & "in" & vbCrLF sTmp = sTmp & "Zone 1: " & sZ1 & vbCrLf sTmp = sTmp & "Zone 2: " & sZ2 & vbCrLf sTmp = sTmp & "Zone 3: " & sZ3 & vbCrLf sTmp = sTmp & "Zone 4: " & sZ4 & vbCrLf sTmp = sTmp & "Zone 5: " & sZ5 & vbCrLf sTmp = sTmp & "Zone 6: " & sZ6 & vbCrLf sTmp = sTmp & "Zone 7: " & sZ7 & vbCrLf sTmp = sTmp & "Zone 8: " & sZ8 & vbCrLf sTmp = sTmp & "Zone 9: " & sZ9 & vbCrLf sTmp = sTmp & "Zone 10: " & sZ10 & vbCrLf sTmp = sTmp & "_______________________________________________________________________" & vbCrLf Set objCDO = Server.CreateObject("CDONTS.NewMail") objCDO.From = "info@thehairlosscenter.com" objCDO.To = "info@thehairlosscenter.com" objCDO.Cc = "bcohenmd@bellsouth.net" objCDO.Subject = "Online Consult" objCDO.Body = sTmp objCDO.Send() Set objCDO = Nothing Response.Redirect("learnmore_testing.html") End If %> Online Consultation - The Hair Loss Center - Dr Bernard Cohen - Transplantation - Restoration - Removal - Replacement - Miami

Using the graphic below, identify the 10 zones on your scalp. Click the graphic to enlarge.
A line drawn from the top of the ears across the back of the head marks the top of zone 10.

CLICK TO ENLARGE

There are three sets of dots. Measure the distance between the dots on your forehead, with a flexible ruler. You may use a blank piece of paper to mark the distances and then measure the marks that you've made on the paper.
Next, measure the distances between the dots in area 4 and area 5v. They should be measured and recorded only if they can be clearly seen.
If the distance between the dots on the forehead is greater than 11cm (inches) ,assume that Zone 2 no longer exists.

Record the values for the distances below. Use either centimeters or inches.

FOREHEAD	cm inches
ZONE 4	cm inches
ZONE 5V	cm inches

Next prepare to measure the severity of hair loss in each of the zones using the scale below. The hair loss severity is determined by the visual ratio of hair to skin.

HAIR LOSS SEVERITY	HAIR TO SKIN RATIO
No Loss	All Hair
Minimal Loss	Much More Hair Than Skin
Mild	More Hair Than Skin
Moderate	More Skin Than Hair
Severe	Much More Skin Than Hair
No Hair	All Skin

Examples of Hair Loss Severity are shown below:

Minimal Loss	Mild	Moderate	Severe

CLICK TO ENLARGE	CLICK TO ENLARGE	CLICK TO ENLARGE	CLICK TO ENLARGE

Now score the severity of hair loss each zone. Manipulate or comb the hair to see the scalp surface more clearly. Note the values in the chart below by assigning minimal loss, mild, moderate, etc., to each of the Zones. Zone 10 is almost always assigned the value of NO LOSS. Use Zone 10 as a basis of comparison for the other 9 Zones.

	NO LOSS	MINIMAL LOSS	MILD	MODERATE	SEVERE	NO HAIR
ZONE 1	>	>	>	>	>	>
ZONE 2	>	>	>	>	>	>
ZONE 3	>	>	>	>	>	>
ZONE 4	>	>	>	>	>	>
ZONE 5	>	>	>	>	>	>
ZONE 6	>	>	>	>	>	>
ZONE 7	>	>	>	>	>	>
ZONE 8	>	>	>	>	>	>
ZONE 9	>	>	>	>	>	>
ZONE 10	>	>	>	>	>	>
	<% = sError %>
Name:
Email:
Phone:

NO PHOTOGRAPHS ARE REQUIRED. This method is significantly more accurate. A response will follow the same day with diagnosis, recommendations, and approximate estimates of cost.