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Patient Intake Form

Please fill out our medical intake form prior to your consultation or procedure.

Intake Form

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.
Refill Request Form

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Whether you’re looking for hair restoration centers in Boston or hair restoration centers in Connecticut, the best hair transplant needs the best hair restoration surgeon. To get the best FUE or FUT hair transplant, choose DiStefano Hair Loss Restoration Centers.

Contact Us

Locations

292 Lincoln Street
Worcester, MA 01605

215 Toll Gate Rd. Suite 308
Warwick, RI 02886

  • New Hampshire

80 Palomino Lane. Lower Level: Unit 202
Bedford, NH 03110

  • Massachusetts

175 Bedford St. Suite 5
Lexington, MA 02420

  • Connecticut

100 Corporate Place
Rocky Hill, CT 06067

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