Patient Portal

Intake Form

This form is required before your first consultation with us, or if we have not seen you in the past 12 months.

Prescription Refills

If you need a refill for your 82m / 82f / Finasteride / or Propecia. Please fill out this form and we will process your refill the same business day if received before 3:00PM.

Lab Slips

If one of our staff members recommended blood work, you may download them here and bring them to your lab of choice.

DiStefano Hair Restoration Center