Orange County Hair Restoration

Appointment Request Form

Appointment Request Form

OC Hair restoration book an appointment
  • Date Format: MM slash DD slash YYYY
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  • NOTICE: HIPAA AUTHORIZATION REQUIRED TO USE THIS FORM. SIGNATURE FIELD BELOW.

    HIPAA AUTHORIZATION. To the extent information in this form is protected health information under the Health Insurance Portability and Accountability Act, as amended, and its regulations (“HIPAA”), I authorize the use and disclosure of such information in accordance with this HIPAA AUTHORIZATION. I authorize the use and disclosure of all of the information that I have entered into this form. I certify that I am the individual whose information is included in this form or I am the individual’s representative. The purpose of this disclosure is to allow communication of the patient information to OC Hair Restoration. The Information will be disclosed to OC Hair Restoration and/or its information technology contractors in order to facilitate communication between me and the medical practice. I understand that I have the right to revoke this Authorization at any time prior to my submission of this form by simply not signing this Authorization, but once I sign this Authorization and submit the form, the information will be disclosed to Recipients in reliance upon my Authorization. I understand that I am not required to sign this Authorization and that any medical practice making this form available on its website may not condition my treatment on whether I use this Secure Form to communicate with the medical practice. This Authorization has no expiration date. I understand that the Information used or disclosed pursuant to this Authorization may be subject to re-disclosure by the Recipients and will no longer be protected by HIPAA. I hereby acknowledge that I may print a copy of this Authorization for my records.

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Patient Testimonials

My experience was nothing less than perfect. The entire staff is wonderful and very friendly. The atmosphere is calm and relaxing. They’re very keen on being ‘connected’ to the client and making you feel comfortable while providing a professional demeanor. They did a fantastic job on explaining the process of the procedure. I LOVED the e-mail/texts reminding me of my appointment and thank you notifications. I would and am going to refer my friends and family.

Dear Dr. Ken,

I really enjoyed meeting you yesterday and wish all doctors were like you. I was dead set on not getting any surgical procedures and thought for sure after our meeting I would feel the same way. However, between you and the education you guys gave me, I’ve changed my mind. I have to wait until next April before surgery, but I will start using Propecia and Rogain in the manner you recommended… I wanted to not like you guys and come home to tell my wife “no way”, but instead, I’m developing a love for you guys and look forward to our future relations. Thank you for being so cool!

Hi Dr. Williams,

I just really wanted to thank you again for all your time today. I finally felt that I was in a comfortable environment with a doctor that actually cares for his patients, something that is tough to come by these days. It came a shock to me that you were the first doctor who told me to be patient versus jumping into the operation room, and for that I truly thank you. I wish there were more doctors like you in the world today, and I’m very very thankful I was able to find such a great doctor. I hope to stabilize this process as much as I can, and will continue to do your suggested treatment. I look forward to our second consult in the near future.

The experience was like going to a family members home… very sweet &
caring office staff.

Terrific visit – very knowledgeable doctor – clear and comprehensive explaining of options and procedures – beautiful woman at front desk made me feel welcome and added to the overall warmth and professionalism of the entire staff.

Hey Dr. Ken,
Thanks so much for helping my hair follicles grow up healthier and stronger.
Your personality and methods are above and beyond any other doctor I’ve ever been to. Really stoked. Looking forward to the next year.

I am astounded by the exemplary level of care I receive. I couldn’t be more pleased.

Thanks for taking the time to go over all the details during my appointment. This was by far the most comprehensive consultation that I have had among the four doctors that I have seen over the past two weeks. After talking to Dr. Williams and reviewing some of the material that he had emailed, I feel very comfortable moving forward with FUE hair transplant procedure with him.

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