Hair Restoration Consultation - LUMINA Regenerative Wellness

01

STEP 1 — ABOUT YOU

Tell us about you and your hair.

Full name *

Sex *

Male Female Prefer not to say

WhatsApp number *Include your country code, e.g. +234.

Email address *

Age *Minimum 18.

Current city and country *Assessment and treatment take place in Ikoyi, Lagos.

Which area would you like us to assess? *Select all that apply.

Front hairline Temples or corners Top thinning area Several areas Beard or eyebrows

Have you had any previous hair-restoration treatment? *

Yes No

How long has this thinning been active? *

Under 1 year 1–3 years 3–5 years 5+ years

02

STEP 2 — CHOOSE YOUR ROUTE

Which option would you like us to review for you?

i

The ₦1.5M option is limited and clinic-selected. Applications remain open only until the clinic has shortlisted enough suitable candidates. Applying does not automatically secure the ₦1.5M rate.

₦3,500,000

Result images without showing my full face.

PRIVATE RESULT ROUTE

₦2,500,000

Agreed photos/videos showing my full face.

FULL-FACE PARTICIPATION

LIMITED · CLINIC SELECTED₦1,500,000

Apply for a limited clinic-selected case-study place.

CASE-STUDY APPLICATION

03

STEP 3 — ₦1.5M SELECTED CASE-STUDY ROUTE

This is a limited clinic-selected opportunity.

✦

If selected, you must be ready to:

Pay a ₦500,000 deposit within 24 hours to secure your place.
Attend your clinic assessment in Ikoyi within 7 days.
Complete the agreed before-and-after photo/video requirements and follow-up visits.

Because places are limited, a selected place may be released if these timelines are not met.

I understand the selected case-study requirements.This confirms readiness only; it does not guarantee selection.

04

STEP 4 — LET US SEE YOUR HAIR

Upload 3 clear hair photos.

These are for clinic review. They will not be published without a separate agreement.

PHOTO

Front photo *

Face forward in good light. Keep your hairline clearly visible.

📷 Take photo＋ Choose from phone

No photo selected

PHOTO

Top photo *

Tilt your head slightly down so we can clearly see the top thinning area.

📷 Take photo＋ Choose from phone

No photo selected

PHOTO

Back photo *

Show the full-density back zone clearly in good light.

📷 Take photo＋ Choose from phone

No photo selected

If our team shortlists you, how soon can you come to our Ikoyi clinic for assessment? *

Today or tomorrow Within 3 days Within 7 days Within 2–4 weeks Later — please contact me

Privacy acknowledgement *I agree that LUMINA/Cynosure may review my details and hair photos and contact me about this application.

Date *

LUMINA Hair Restoration Application

See the results before you apply.

Begin your application.

Tell us about you and your hair.

Which option would you like us to review for you?

This is a limited clinic-selected opportunity.

Upload 3 clear hair photos.

Front photo *

Top photo *

Back photo *

Thank you.