My Hair Clinic - Assessment Form<\/title>\n <script src=\"https:\/\/js.hcaptcha.com\/1\/api.js\" async defer><\/script>\n<\/head>\n\n<style>\n\/* Brand Colors: Black #000000, Gold #BFA866, White #FFFFFF *\/\n* {\n margin: 0;\n padding: 0;\n box-sizing: border-box;\n}\n\nbody {\n font-family: 'Lato', system-ui, Arial, sans-serif;\n background-color: #000000;\n color: #FFFFFF;\n line-height: 1.6;\n min-height: 100vh;\n}\n\n.calculator-container {\n max-width: 800px;\n margin: 0 auto;\n padding: 20px;\n}\n\n\/* Typography *\/\nh1, h2, h3 {\n font-family: 'Playfair Display', Georgia, Times, serif;\n color: #BFA866 !important;\n margin-bottom: 1rem;\n}\n\nh1 {\n font-size: 2.5rem !important;\n text-align: center !important;\n margin-bottom: 2rem !important;\n letter-spacing: 2px !important;\n}\n\nh2 {\n font-size: 1.8rem;\n border-bottom: 2px solid #BFA866;\n padding-bottom: 0.5rem;\n margin-bottom: 1.5rem;\n}\n\nh3 {\n font-size: 1.3rem;\n margin-bottom: 1rem;\n}\n\n\/* Form Sections 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0.3s;\n}\n\n.toggle.active::after {\n transform: translateX(30px);\n}\n\n\/* Radio button styling *\/\n.radio-group {\n display: flex;\n gap: 2rem;\n margin-top: 0.75rem;\n align-items: center;\n}\n\n.radio-item {\n display: flex;\n align-items: center;\n gap: 0.5rem;\n}\n\n.radio-item input[type=\"radio\"] {\n width: auto !important;\n margin: 0 !important;\n transform: scale(1.2);\n accent-color: #BFA866;\n}\n\n.radio-item label {\n margin: 0 !important;\n color: #FFFFFF !important;\n font-weight: normal;\n cursor: pointer;\n}\n\n\/* Buttons *\/\n.btn {\n background: #BFA866;\n color: #000000;\n border: none;\n padding: 1rem 2rem;\n border-radius: 4px;\n font-size: 1.1rem;\n font-weight: 600;\n cursor: pointer;\n transition: all 0.3s ease;\n text-transform: uppercase;\n letter-spacing: 1px;\n}\n\n.btn:hover {\n background: #d4be7a;\n transform: translateY(-2px);\n}\n\n.btn:disabled {\n background: #666;\n cursor: not-allowed;\n transform: none;\n}\n\n\/* Alert Boxes *\/\n.alert {\n 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!important;\n}\n<\/style>\n\n<body>\n\n<div class=\"calculator-container\">\n <header>\n <h1>MY HAIR CLINIC<\/h1>\n <p style=\"text-align: center; color: #BFA866; font-size: 1.1rem; margin-bottom: 2rem;\">\n Advanced FUE Hair Transplantation - Assessment Form\n <\/p>\n <\/header>\n\n <form id=\"assessmentForm\">\n \n <section class=\"form-section\">\n <h2>Patient Information<\/h2>\n \n <div class=\"form-group\">\n <label for=\"patientName\">Full Name *<\/label>\n <input type=\"text\" id=\"patientName\" name=\"patientName\" required>\n <\/div>\n\n <div class=\"form-group\">\n <label for=\"patientEmail\">Email *<\/label>\n <input type=\"email\" id=\"patientEmail\" name=\"patientEmail\" required>\n <\/div>\n\n <div class=\"form-group\">\n <label for=\"patientPhone\">Phone Number *<\/label>\n <input type=\"tel\" id=\"patientPhone\" name=\"patientPhone\" required>\n <\/div>\n\n <div class=\"form-group\">\n <label for=\"patientAge\">Age *<\/label>\n <input type=\"number\" id=\"patientAge\" name=\"patientAge\" min=\"18\" max=\"80\" required>\n <\/div>\n\n <div class=\"form-group\">\n <label for=\"locationPreference\">Preferred Location<\/label>\n <select id=\"locationPreference\" name=\"locationPreference\">\n <option value=\"\">Select preferred location<\/option>\n <option value=\"Dubai\">Dubai<\/option>\n <option value=\"Oslo\">Oslo<\/option>\n <option value=\"Islamabad\">Islamabad<\/option>\n <\/select>\n <\/div>\n <\/section>\n\n \n <section class=\"form-section\">\n <h2>Areas to Restore<\/h2>\n <p>Select the areas you wish to restore (at least one required):<\/p>\n <p style=\"font-size: 0.9rem; color: #BFA866; margin-top: 0.5rem;\">Note: You can select one front area option + crown if needed<\/p>\n \n <div class=\"checkbox-group\">\n <div class=\"checkbox-item\">\n <input type=\"checkbox\" id=\"areaFront\" name=\"frontOption\" value=\"frontOnly\">\n <label for=\"areaFront\">Front Hairline<\/label>\n <\/div>\n <div class=\"checkbox-item\">\n <input type=\"checkbox\" id=\"areaFrontTemples\" name=\"frontOption\" value=\"frontTemples\">\n <label for=\"areaFrontTemples\">Front Hairline + Temples<\/label>\n <\/div>\n <div class=\"checkbox-item\">\n <input type=\"checkbox\" id=\"areaFrontTemplesMid\" name=\"frontOption\" value=\"frontTemplesMid\">\n <label for=\"areaFrontTemplesMid\">Front Hairline + Temples + Mid-Scalp<\/label>\n <\/div>\n <div class=\"checkbox-item\">\n <input type=\"checkbox\" id=\"areaCrown\" name=\"crownOption\" value=\"crown\">\n <label for=\"areaCrown\">Crown<\/label>\n <\/div>\n <\/div>\n <\/section>\n\n \n <section class=\"form-section\">\n <h2>Hair Characteristics (Optional)<\/h2>\n <p>These factors help refine your assessment:<\/p>\n \n <div class=\"char-grid\">\n <div class=\"form-group\">\n <label for=\"hairCaliber\">Hair Thickness<\/label>\n <select id=\"hairCaliber\" name=\"hairCaliber\">\n <option value=\"medium\">Medium (Most common)<\/option>\n <option value=\"fine\">Fine<\/option>\n <option value=\"coarse\">Coarse<\/option>\n <\/select>\n <\/div>\n\n <div class=\"form-group\">\n <label for=\"donorDensity\">Donor Area Density<\/label>\n <select id=\"donorDensity\" name=\"donorDensity\">\n <option value=\"average\">Average<\/option>\n <option value=\"high\">High<\/option>\n <option value=\"low\">Low<\/option>\n <\/select>\n <\/div>\n\n <div class=\"form-group\">\n <label for=\"hairCurl\">Hair Texture<\/label>\n <select id=\"hairCurl\" name=\"hairCurl\">\n <option value=\"straight\">Straight<\/option>\n <option value=\"wavy\">Wavy<\/option>\n <option value=\"curly\">Curly<\/option>\n <\/select>\n <\/div>\n <\/div>\n <\/section>\n\n \n <section class=\"form-section\">\n <h2>Medical History<\/h2>\n \n <div class=\"form-group\">\n <label>Have you had any previous hair transplant surgery?<\/label>\n <div class=\"radio-group\">\n <div class=\"radio-item\">\n <input type=\"radio\" id=\"priorYes\" name=\"priorSurgery\" value=\"true\">\n <label for=\"priorYes\">Yes<\/label>\n <\/div>\n <div class=\"radio-item\">\n <input type=\"radio\" id=\"priorNo\" name=\"priorSurgery\" value=\"false\" checked>\n <label for=\"priorNo\">No<\/label>\n <\/div>\n <\/div>\n \n <div id=\"priorSurgeryNote\" class=\"alert alert-warning hidden\" style=\"margin-top: 1rem;\">\n <small>Note: Repair cases may require modified planning and additional consultation.<\/small>\n <\/div>\n <\/div>\n\n <div class=\"form-group\">\n <div class=\"toggle-container\">\n <span>Still losing hair \/ Haven't lost everything yet<\/span>\n <div class=\"toggle\" id=\"notLostEverythingToggle\"><\/div>\n <input type=\"hidden\" id=\"notLostEverything\" name=\"notLostEverything\" value=\"false\">\n <\/div>\n <small style=\"color: #FFFFFF; display: block; margin-top: 0.5rem;\">\n Enable this if you're experiencing ongoing hair loss or in early stages\n <\/small>\n <\/div>\n <\/section>\n\n \n <section class=\"form-section\">\n <div class=\"form-group\">\n <div class=\"checkbox-item\">\n <input type=\"checkbox\" id=\"consent\" name=\"consent\" required>\n <label for=\"consent\">\n I understand this is an assessment and consent to My Hair Clinic contacting me about my hair restoration consultation. *\n <\/label>\n <\/div>\n <\/div>\n\n \n <div class=\"hcaptcha-container\">\n <div class=\"h-captcha\" \n data-sitekey=\"905e131c-2d2c-435c-a188-5fccbf7ee882\" \n data-theme=\"dark\">\n <\/div>\n <\/div>\n <\/section>\n\n \n <div style=\"text-align: center; margin: 2rem 0;\">\n <button type=\"button\" id=\"submitBtn\" class=\"btn\">Submit Assessment<\/button>\n <\/div>\n <\/form>\n\n \n <footer class=\"footer\">\n <div class=\"contact-info\">\n <strong style=\"color: #BFA866;\">Contact My Hair Clinic<\/strong><br>\n UAE WhatsApp: +971 58 247 0065 | International WhatsApp: +47 939 23 223<br>\n Email: info@myhairclinic.ae | info@myhairclinic.com\n <\/div>\n <div>\n <strong>Dubai Clinic:<\/strong> 4013, Block C, Al Razi Medical Complex, Building 64, DHCC, Dubai, UAE<br>\n <em>Free online consultation available. No walk-ins.<\/em>\n <\/div>\n <\/footer>\n<\/div>\n\n<script>\nconst CONFIG = {\n areaRanges: {\n frontOnly: { min: 800, max: 1100 },\n frontTemples: { min: 1700, max: 2000 },\n frontTemplesMid: { min: 2700, max: 3200 },\n crown: { min: 2000, max: 2200 }\n }\n};\n\ndocument.addEventListener('DOMContentLoaded', function() {\n initializeForm();\n});\n\nfunction initializeForm() {\n setupEventListeners();\n setupToggle();\n setupAreaCheckboxes();\n}\n\nfunction setupEventListeners() {\n document.getElementById('submitBtn').addEventListener('click', submitAssessment);\n document.querySelectorAll('input[name=\"priorSurgery\"]').forEach(radio => {\n radio.addEventListener('change', handlePriorSurgeryChange);\n });\n \n document.querySelectorAll('input[name=\"frontOption\"]').forEach(checkbox => {\n checkbox.addEventListener('change', function() {\n if (this.checked) {\n document.querySelectorAll('input[name=\"frontOption\"]').forEach(other => {\n if (other !== this) other.checked = false;\n });\n }\n });\n });\n}\n\nfunction setupToggle() {\n const toggle = document.getElementById('notLostEverythingToggle');\n const hiddenInput = document.getElementById('notLostEverything');\n \n toggle.addEventListener('click', function() {\n this.classList.toggle('active');\n hiddenInput.value = this.classList.contains('active').toString();\n });\n}\n\nfunction setupAreaCheckboxes() {\n const areaCheckboxes = document.querySelectorAll('input[name=\"frontOption\"], input[name=\"crownOption\"]');\n \n areaCheckboxes.forEach(checkbox => {\n checkbox.addEventListener('change', function() {\n const checkboxItem = this.closest('.checkbox-item');\n if (this.checked) {\n checkboxItem.classList.add('checked');\n } else {\n checkboxItem.classList.remove('checked');\n }\n });\n });\n}\n\nfunction handlePriorSurgeryChange() {\n const priorNote = document.getElementById('priorSurgeryNote');\n const priorYes = document.getElementById('priorYes').checked;\n \n if (priorYes) {\n priorNote.classList.remove('hidden');\n } else {\n priorNote.classList.add('hidden');\n }\n}\n\nfunction validateForm() {\n const errors = [];\n \n const name = document.getElementById('patientName').value.trim();\n if (!name) {\n errors.push('Name is required');\n }\n \n const email = document.getElementById('patientEmail').value.trim();\n const phone = document.getElementById('patientPhone').value.trim();\n if (!email && !phone) {\n errors.push('Please provide either email or phone number');\n }\n \n const selectedAreas = getSelectedAreas();\n if (selectedAreas.length === 0) {\n errors.push('Please select at least one area to restore');\n }\n \n const consent = document.getElementById('consent').checked;\n if (!consent) {\n errors.push('Please provide consent to proceed');\n }\n \n \/\/ Validate hCaptcha - get response from textarea\n const hcaptchaTextarea = document.querySelector('textarea[name=\"h-captcha-response\"]');\n if (!hcaptchaTextarea || !hcaptchaTextarea.value) {\n errors.push('Please complete the CAPTCHA verification');\n }\n \n return errors;\n}\n\nfunction buildEmailMessage(patientName, estimates, patientAge, selectedAreas) {\n const isCrownSelected = selectedAreas.includes('crown');\n const subject = \"Your Hair Transplant Estimate from My Hair Clinic\";\n \n if (patientAge && patientAge < 35 && isCrownSelected) {\n const body = `Hi ${patientName},\n\nThank you for using our graft calculator.\n\nYour estimated number of grafts is: ${estimates.total.min} \u2013 ${estimates.total.max}\n\nHowever, we generally do not recommend transplantation to the crown under 35, as using grafts there too early can compromise long-term results.\n\nWhat we suggest\n\nWe recommend you book a 60-minute consultation with Dr. Hussain. During this, you'll receive:\n\n\u2022 A clear, personalised plan\n\u2022 A more precise estimate of how many grafts can be transplanted\n\u2022 Guidance on what we can aim for in the short and long term\n\nBest regards,\nMy Hair Clinic\n\nWhatsApp: +971 58 247 0065 | Email: info@myhairclinic.com\n\nDisclaimer: This is an automated estimate and not a medical decision. Final recommendations follow an individual consultation with Dr. Hussain.`;\n return { subject, body };\n }\n else if (patientAge && patientAge >= 35 && isCrownSelected) {\n const body = `Hi ${patientName},\n\nThank you for using our graft calculator.\nYour estimated number of grafts is ${estimates.total.min} \u2013 ${estimates.total.max}\n\nBecause you selected treatment for the crown, it's important to know that Dr. Hussain generally recommends a staged approach, starting with the front and mid-scalp first. These areas frame your face and have the greatest impact on your appearance.\n\nThe crown may be addressed later if your donor capacity (scalp \u00b1 beard\/body) is sufficient.\n\nWhat we suggest\nWe recommend you book a 60-minute consultation with Dr. Hussain. During this, you'll receive:\n\n\u2022 A clear, personalised treatment plan\n\u2022 A more precise estimate of grafts for each stage\n\u2022 Guidance on what we can realistically achieve in the short and long term\n\nBest regards,\nMy Hair Clinic\n\nWhatsApp: +971 58 247 0065 | Email: info@myhairclinic.com\n\nDisclaimer: This is an automated estimate and not a medical decision. Final recommendations follow an individual consultation with Dr. Hussain.`;\n return { subject, body };\n }\n else {\n const body = `Hi ${patientName},\n\nThank you for using our graft calculator.\nYour estimated number of grafts is: ${estimates.total.min} \u2013 ${estimates.total.max}\n\nTo make sure you get the best, most natural outcome, we recommend you book a 60-minute consultation with Dr. Hussain. During this, you'll receive:\n\n\u2022 A clear, personalised treatment plan\n\u2022 A more precise estimate of how many grafts can be transplanted\n\u2022 Guidance on what we can aim for in the short and long term\n\nBest regards,\nMy Hair Clinic\n\nWhatsApp: +971 58 247 0065 | Email: info@myhairclinic.com\n\nDisclaimer: This is an automated estimate and not a medical decision. Final recommendations follow an individual consultation with Dr. Hussain.`;\n return { subject, body };\n }\n}\n\nfunction submitAssessment() {\n const errors = validateForm();\n if (errors.length > 0) {\n alert('Please complete the required fields:\\n' + errors.join('\\n'));\n return;\n }\n\n const selectedAreas = getSelectedAreas();\n const estimates = computeAreaRanges(selectedAreas);\n const recommendation = determineRecommendation();\n const assessmentData = buildAssessmentData(estimates, recommendation);\n\n const patientName = document.getElementById('patientName').value.trim();\n const patientAge = parseInt(document.getElementById('patientAge').value) || null;\n const emailMessage = buildEmailMessage(patientName, estimates, patientAge, selectedAreas);\n\n submitToCF7(assessmentData, emailMessage);\n}\n\nfunction getSelectedAreas() {\n const areas = [];\n \n const frontOption = document.querySelector('input[name=\"frontOption\"]:checked');\n if (frontOption) areas.push(frontOption.value);\n \n const crownOption = document.querySelector('input[name=\"crownOption\"]:checked');\n if (crownOption) areas.push(crownOption.value);\n \n return areas;\n}\n\nfunction computeAreaRanges(selectedAreas) {\n const estimates = {\n perArea: {},\n total: { min: 0, max: 0 }\n };\n \n selectedAreas.forEach(area => {\n if (CONFIG.areaRanges[area]) {\n const baseRange = CONFIG.areaRanges[area];\n estimates.perArea[area] = {\n min: baseRange.min,\n max: baseRange.max\n };\n \n estimates.total.min += baseRange.min;\n estimates.total.max += baseRange.max;\n }\n });\n \n return estimates;\n}\n\nfunction determineRecommendation() {\n const notLostEverything = document.getElementById('notLostEverything').value === 'true';\n const selectedAreas = getSelectedAreas();\n const hasCrown = selectedAreas.includes('crown');\n \n if (notLostEverything) {\n return {\n path: 'Medical Hair Restoration + Future FUE Consideration',\n notes: 'Based on assessment, recommend starting with Medical Hair Restoration to slow further hair loss. FUE can be considered later depending on response to treatment.'\n };\n } else if (hasCrown && selectedAreas.length > 1) {\n return {\n path: 'Comprehensive FUE Hair Transplantation',\n notes: 'Based on your selection of multiple areas including the crown, a comprehensive FUE procedure is recommended for full coverage and natural-looking results.'\n };\n } else {\n return {\n path: 'FUE Hair Transplantation',\n notes: 'Based on your selected areas, FUE (Follicular Unit Extraction) hair transplantation is recommended for natural-looking results with minimal scarring.'\n };\n }\n}\n\nfunction buildAssessmentData(estimates, recommendation) {\n const selectedAreas = getSelectedAreas();\n \n const areaNames = [];\n if (selectedAreas.includes('frontOnly')) areaNames.push('Front Hairline Only');\n if (selectedAreas.includes('frontTemples')) areaNames.push('Front Hairline + Temples');\n if (selectedAreas.includes('frontTemplesMid')) areaNames.push('Front Hairline + Temples + Mid-Scalp');\n if (selectedAreas.includes('crown')) areaNames.push('Crown');\n \n let areaEstimatesText = '';\n Object.keys(estimates.perArea).forEach(area => {\n const range = estimates.perArea[area];\n const areaName = getAreaDisplayName(area);\n areaEstimatesText += `${areaName}: ${range.min} - ${range.max} grafts\\n`;\n });\n \n return `HAIR RESTORATION ASSESSMENT\n===========================\n\nPATIENT INFORMATION:\nName: ${document.getElementById('patientName').value.trim()}\nEmail: ${document.getElementById('patientEmail').value.trim() || 'Not provided'}\nPhone: ${document.getElementById('patientPhone').value.trim() || 'Not provided'}\nAge: ${document.getElementById('patientAge').value || 'Not provided'}\nPreferred Location: ${document.getElementById('locationPreference').value || 'Not specified'}\n\nASSESSMENT DETAILS:\nAreas to Restore: ${areaNames.join(', ') || 'None selected'}\nPrior Surgery: ${document.querySelector('input[name=\"priorSurgery\"]:checked').value === 'true' ? 'Yes' : 'No'}\nStill Losing Hair: ${document.getElementById('notLostEverything').value === 'true' ? 'Yes' : 'No'}\n\nHAIR CHARACTERISTICS:\nCaliber: ${document.getElementById('hairCaliber').value}\nDonor Density: ${document.getElementById('donorDensity').value}\nCurl: ${document.getElementById('hairCurl').value}\n\nCALCULATED ESTIMATES:\nTotal Graft Range: ${estimates.total.min} - ${estimates.total.max} grafts\n\nArea Breakdown:\n${areaEstimatesText}\n\nRECOMMENDATION:\nTreatment Path: ${recommendation.path}\nNotes: ${recommendation.notes}\n\nSubmitted: ${new Date().toLocaleString()}\nSource: My Hair Clinic Assessment Calculator`;\n}\n\nfunction getAreaDisplayName(area) {\n const displayNames = {\n frontOnly: 'Front Hairline Only',\n frontTemples: 'Front Hairline + Temples',\n frontTemplesMid: 'Front Hairline + Temples + Mid-Scalp',\n crown: 'Crown'\n };\n return displayNames[area] || area;\n}\n\nfunction submitToCF7(assessmentData, emailMessage) {\n const saveBtn = document.getElementById('submitBtn');\n const originalText = saveBtn.textContent;\n saveBtn.textContent = 'Submitting...';\n saveBtn.disabled = true;\n\n const formData = new FormData();\n const formId = '7562';\n \n formData.append('_wpcf7', formId);\n formData.append('_wpcf7_version', '5.9'); \n formData.append('_wpcf7_locale', 'en_US');\n formData.append('_wpcf7_unit_tag', 'wpcf7-f' + formId + '-o1');\n \n formData.append('patient_name', document.getElementById('patientName').value.trim());\n formData.append('patient_email', document.getElementById('patientEmail').value.trim());\n formData.append('patient_phone', document.getElementById('patientPhone').value.trim());\n formData.append('assessment_data', assessmentData);\n formData.append('email_subject', emailMessage.subject);\n formData.append('email_body', emailMessage.body);\n \n \/\/ Get hCaptcha response from the hidden textarea that hCaptcha creates\n const hcaptchaTextarea = document.querySelector('textarea[name=\"h-captcha-response\"]');\n if (hcaptchaTextarea && hcaptchaTextarea.value) {\n formData.append('h-captcha-response', hcaptchaTextarea.value);\n formData.append('g-recaptcha-response', hcaptchaTextarea.value);\n }\n\n fetch('\/wp-json\/contact-form-7\/v1\/contact-forms\/' + formId + '\/feedback', {\n method: 'POST',\n body: formData\n })\n .then(response => response.json())\n .then(data => {\n console.log('CF7 Response:', data);\n if (data.status === 'mail_sent') {\n window.location.href = 'https:\/\/myhairclinic.com\/thank-you-graft\/';\n } else {\n throw new Error(data.message || 'Submission failed');\n }\n })\n .catch(error => {\n console.error('Submission error:', error);\n alert('Submission failed: ' + error.message + '\\n\\nPlease contact us directly at info@myhairclinic.com');\n saveBtn.textContent = originalText;\n saveBtn.disabled = false;\n \n \/\/ Reset hCaptcha by reloading the widget\n const hcaptchaWidget = document.querySelector('.h-captcha');\n if (hcaptchaWidget && hcaptchaWidget.children.length > 0) {\n const widgetId = hcaptchaWidget.children[0].getAttribute('data-hcaptcha-widget-id');\n if (widgetId && typeof hcaptcha !== 'undefined') {\n try {\n hcaptcha.reset(widgetId);\n } catch (e) {\n console.error('Error resetting hCaptcha:', e);\n }\n }\n }\n });\n}\n\ndocument.addEventListener('wpcf7mailsent', function(event) {\n window.location.href = \"https:\/\/myhairclinic.com\/thank-you-graft\/\";\n}, false);\n<\/script>\n\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>My Hair Clinic – Assessment Form MY HAIR CLINIC Advanced FUE Hair Transplantation – Assessment Form Patient Information Full Name * Email * Phone Number * Age * Preferred Location Select preferred locationDubaiOsloIslamabad Areas to Restore Select the areas you wish to restore (at least one required): Note: You can select one front area option […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-7621","page","type-page","status-publish","hentry"],"yoast_head":"\n<title>Graft Calculator - 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\n\t\t\t\t\t\n\n\n \n \n My Hair Clinic - Assessment Form<\/title>\n <script src=\"https:\/\/js.hcaptcha.com\/1\/api.js\" async defer><\/script>\n<\/head>\n\n<style>\n\/* Brand Colors: Black #000000, Gold #BFA866, White #FFFFFF *\/\n* {\n margin: 0;\n padding: 0;\n box-sizing: border-box;\n}\n\nbody {\n font-family: 'Lato', system-ui, Arial, sans-serif;\n background-color: #000000;\n color: #FFFFFF;\n line-height: 1.6;\n min-height: 100vh;\n}\n\n.calculator-container {\n max-width: 800px;\n margin: 0 auto;\n padding: 20px;\n}\n\n\/* Typography *\/\nh1, h2, h3 {\n font-family: 'Playfair Display', Georgia, Times, serif;\n color: #BFA866 !important;\n margin-bottom: 1rem;\n}\n\nh1 {\n font-size: 2.5rem !important;\n text-align: center !important;\n margin-bottom: 2rem !important;\n letter-spacing: 2px !important;\n}\n\nh2 {\n font-size: 1.8rem;\n border-bottom: 2px solid #BFA866;\n padding-bottom: 0.5rem;\n margin-bottom: 1.5rem;\n}\n\nh3 {\n font-size: 1.3rem;\n margin-bottom: 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!important;\n}\n<\/style>\n\n<body>\n\n<div class=\"calculator-container\">\n <header>\n <h1>MY HAIR CLINIC<\/h1>\n <p style=\"text-align: center; color: #BFA866; font-size: 1.1rem; margin-bottom: 2rem;\">\n Advanced FUE Hair Transplantation - Assessment Form\n <\/p>\n <\/header>\n\n <form id=\"assessmentForm\">\n \n <section class=\"form-section\">\n <h2>Patient Information<\/h2>\n \n <div class=\"form-group\">\n <label for=\"patientName\">Full Name *<\/label>\n <input type=\"text\" id=\"patientName\" name=\"patientName\" required>\n <\/div>\n\n <div class=\"form-group\">\n <label for=\"patientEmail\">Email *<\/label>\n <input type=\"email\" id=\"patientEmail\" name=\"patientEmail\" required>\n <\/div>\n\n <div class=\"form-group\">\n <label for=\"patientPhone\">Phone Number *<\/label>\n <input type=\"tel\" id=\"patientPhone\" name=\"patientPhone\" required>\n <\/div>\n\n <div class=\"form-group\">\n <label for=\"patientAge\">Age *<\/label>\n <input type=\"number\" id=\"patientAge\" name=\"patientAge\" min=\"18\" max=\"80\" required>\n <\/div>\n\n <div class=\"form-group\">\n <label for=\"locationPreference\">Preferred Location<\/label>\n <select id=\"locationPreference\" name=\"locationPreference\">\n <option value=\"\">Select preferred location<\/option>\n <option value=\"Dubai\">Dubai<\/option>\n <option value=\"Oslo\">Oslo<\/option>\n <option value=\"Islamabad\">Islamabad<\/option>\n <\/select>\n <\/div>\n <\/section>\n\n \n <section class=\"form-section\">\n <h2>Areas to Restore<\/h2>\n <p>Select the areas you wish to restore (at least one required):<\/p>\n <p style=\"font-size: 0.9rem; color: #BFA866; margin-top: 0.5rem;\">Note: You can select one front area option + crown if needed<\/p>\n \n <div class=\"checkbox-group\">\n <div class=\"checkbox-item\">\n <input type=\"checkbox\" id=\"areaFront\" name=\"frontOption\" value=\"frontOnly\">\n <label for=\"areaFront\">Front Hairline<\/label>\n <\/div>\n <div class=\"checkbox-item\">\n <input type=\"checkbox\" id=\"areaFrontTemples\" name=\"frontOption\" value=\"frontTemples\">\n <label for=\"areaFrontTemples\">Front Hairline + Temples<\/label>\n <\/div>\n <div class=\"checkbox-item\">\n <input type=\"checkbox\" id=\"areaFrontTemplesMid\" name=\"frontOption\" value=\"frontTemplesMid\">\n <label for=\"areaFrontTemplesMid\">Front Hairline + Temples + Mid-Scalp<\/label>\n <\/div>\n <div class=\"checkbox-item\">\n <input type=\"checkbox\" id=\"areaCrown\" name=\"crownOption\" value=\"crown\">\n <label for=\"areaCrown\">Crown<\/label>\n <\/div>\n <\/div>\n <\/section>\n\n \n <section class=\"form-section\">\n <h2>Hair Characteristics (Optional)<\/h2>\n <p>These factors help refine your assessment:<\/p>\n \n <div class=\"char-grid\">\n <div class=\"form-group\">\n <label for=\"hairCaliber\">Hair Thickness<\/label>\n <select id=\"hairCaliber\" name=\"hairCaliber\">\n <option value=\"medium\">Medium (Most common)<\/option>\n <option value=\"fine\">Fine<\/option>\n <option value=\"coarse\">Coarse<\/option>\n <\/select>\n <\/div>\n\n <div class=\"form-group\">\n <label for=\"donorDensity\">Donor Area Density<\/label>\n <select id=\"donorDensity\" name=\"donorDensity\">\n <option value=\"average\">Average<\/option>\n <option value=\"high\">High<\/option>\n <option value=\"low\">Low<\/option>\n <\/select>\n <\/div>\n\n <div class=\"form-group\">\n <label for=\"hairCurl\">Hair Texture<\/label>\n <select id=\"hairCurl\" name=\"hairCurl\">\n <option value=\"straight\">Straight<\/option>\n <option value=\"wavy\">Wavy<\/option>\n <option value=\"curly\">Curly<\/option>\n <\/select>\n <\/div>\n <\/div>\n <\/section>\n\n \n <section class=\"form-section\">\n <h2>Medical History<\/h2>\n \n <div class=\"form-group\">\n <label>Have you had any previous hair transplant surgery?<\/label>\n <div class=\"radio-group\">\n <div class=\"radio-item\">\n <input type=\"radio\" id=\"priorYes\" name=\"priorSurgery\" value=\"true\">\n <label for=\"priorYes\">Yes<\/label>\n <\/div>\n <div class=\"radio-item\">\n <input type=\"radio\" id=\"priorNo\" name=\"priorSurgery\" value=\"false\" checked>\n <label for=\"priorNo\">No<\/label>\n <\/div>\n <\/div>\n \n <div id=\"priorSurgeryNote\" class=\"alert alert-warning hidden\" style=\"margin-top: 1rem;\">\n <small>Note: Repair cases may require modified planning and additional consultation.<\/small>\n <\/div>\n <\/div>\n\n <div class=\"form-group\">\n <div class=\"toggle-container\">\n <span>Still losing hair \/ Haven't lost everything yet<\/span>\n <div class=\"toggle\" id=\"notLostEverythingToggle\"><\/div>\n <input type=\"hidden\" id=\"notLostEverything\" name=\"notLostEverything\" value=\"false\">\n <\/div>\n <small style=\"color: #FFFFFF; display: block; margin-top: 0.5rem;\">\n Enable this if you're experiencing ongoing hair loss or in early stages\n <\/small>\n <\/div>\n <\/section>\n\n \n <section class=\"form-section\">\n <div class=\"form-group\">\n <div class=\"checkbox-item\">\n <input type=\"checkbox\" id=\"consent\" name=\"consent\" required>\n <label for=\"consent\">\n I understand this is an assessment and consent to My Hair Clinic contacting me about my hair restoration consultation. *\n <\/label>\n <\/div>\n <\/div>\n\n \n <div class=\"hcaptcha-container\">\n <div class=\"h-captcha\" \n data-sitekey=\"905e131c-2d2c-435c-a188-5fccbf7ee882\" \n data-theme=\"dark\">\n <\/div>\n <\/div>\n <\/section>\n\n \n <div style=\"text-align: center; margin: 2rem 0;\">\n <button type=\"button\" id=\"submitBtn\" class=\"btn\">Submit Assessment<\/button>\n <\/div>\n <\/form>\n\n \n <footer class=\"footer\">\n <div class=\"contact-info\">\n <strong style=\"color: #BFA866;\">Contact My Hair Clinic<\/strong><br>\n UAE WhatsApp: +971 58 247 0065 | International WhatsApp: +47 939 23 223<br>\n Email: info@myhairclinic.ae | info@myhairclinic.com\n <\/div>\n <div>\n <strong>Dubai Clinic:<\/strong> 4013, Block C, Al Razi Medical Complex, Building 64, DHCC, Dubai, UAE<br>\n <em>Free online consultation available. No walk-ins.<\/em>\n <\/div>\n <\/footer>\n<\/div>\n\n<script>\nconst CONFIG = {\n areaRanges: {\n frontOnly: { min: 800, max: 1100 },\n frontTemples: { min: 1700, max: 2000 },\n frontTemplesMid: { min: 2700, max: 3200 },\n crown: { min: 2000, max: 2200 }\n }\n};\n\ndocument.addEventListener('DOMContentLoaded', function() {\n initializeForm();\n});\n\nfunction initializeForm() {\n setupEventListeners();\n setupToggle();\n setupAreaCheckboxes();\n}\n\nfunction setupEventListeners() {\n document.getElementById('submitBtn').addEventListener('click', submitAssessment);\n document.querySelectorAll('input[name=\"priorSurgery\"]').forEach(radio => {\n radio.addEventListener('change', handlePriorSurgeryChange);\n });\n \n document.querySelectorAll('input[name=\"frontOption\"]').forEach(checkbox => {\n checkbox.addEventListener('change', function() {\n if (this.checked) {\n document.querySelectorAll('input[name=\"frontOption\"]').forEach(other => {\n if (other !== this) other.checked = false;\n });\n }\n });\n });\n}\n\nfunction setupToggle() {\n const toggle = document.getElementById('notLostEverythingToggle');\n const hiddenInput = document.getElementById('notLostEverything');\n \n toggle.addEventListener('click', function() {\n this.classList.toggle('active');\n hiddenInput.value = this.classList.contains('active').toString();\n });\n}\n\nfunction setupAreaCheckboxes() {\n const areaCheckboxes = document.querySelectorAll('input[name=\"frontOption\"], input[name=\"crownOption\"]');\n \n areaCheckboxes.forEach(checkbox => {\n checkbox.addEventListener('change', function() {\n const checkboxItem = this.closest('.checkbox-item');\n if (this.checked) {\n checkboxItem.classList.add('checked');\n } else {\n checkboxItem.classList.remove('checked');\n }\n });\n });\n}\n\nfunction handlePriorSurgeryChange() {\n const priorNote = document.getElementById('priorSurgeryNote');\n const priorYes = document.getElementById('priorYes').checked;\n \n if (priorYes) {\n priorNote.classList.remove('hidden');\n } else {\n priorNote.classList.add('hidden');\n }\n}\n\nfunction validateForm() {\n const errors = [];\n \n const name = document.getElementById('patientName').value.trim();\n if (!name) {\n errors.push('Name is required');\n }\n \n const email = document.getElementById('patientEmail').value.trim();\n const phone = document.getElementById('patientPhone').value.trim();\n if (!email && !phone) {\n errors.push('Please provide either email or phone number');\n }\n \n const selectedAreas = getSelectedAreas();\n if (selectedAreas.length === 0) {\n errors.push('Please select at least one area to restore');\n }\n \n const consent = document.getElementById('consent').checked;\n if (!consent) {\n errors.push('Please provide consent to proceed');\n }\n \n \/\/ Validate hCaptcha - get response from textarea\n const hcaptchaTextarea = document.querySelector('textarea[name=\"h-captcha-response\"]');\n if (!hcaptchaTextarea || !hcaptchaTextarea.value) {\n errors.push('Please complete the CAPTCHA verification');\n }\n \n return errors;\n}\n\nfunction buildEmailMessage(patientName, estimates, patientAge, selectedAreas) {\n const isCrownSelected = selectedAreas.includes('crown');\n const subject = \"Your Hair Transplant Estimate from My Hair Clinic\";\n \n if (patientAge && patientAge < 35 && isCrownSelected) {\n const body = `Hi ${patientName},\n\nThank you for using our graft calculator.\n\nYour estimated number of grafts is: ${estimates.total.min} \u2013 ${estimates.total.max}\n\nHowever, we generally do not recommend transplantation to the crown under 35, as using grafts there too early can compromise long-term results.\n\nWhat we suggest\n\nWe recommend you book a 60-minute consultation with Dr. Hussain. During this, you'll receive:\n\n\u2022 A clear, personalised plan\n\u2022 A more precise estimate of how many grafts can be transplanted\n\u2022 Guidance on what we can aim for in the short and long term\n\nBest regards,\nMy Hair Clinic\n\nWhatsApp: +971 58 247 0065 | Email: info@myhairclinic.com\n\nDisclaimer: This is an automated estimate and not a medical decision. Final recommendations follow an individual consultation with Dr. Hussain.`;\n return { subject, body };\n }\n else if (patientAge && patientAge >= 35 && isCrownSelected) {\n const body = `Hi ${patientName},\n\nThank you for using our graft calculator.\nYour estimated number of grafts is ${estimates.total.min} \u2013 ${estimates.total.max}\n\nBecause you selected treatment for the crown, it's important to know that Dr. Hussain generally recommends a staged approach, starting with the front and mid-scalp first. These areas frame your face and have the greatest impact on your appearance.\n\nThe crown may be addressed later if your donor capacity (scalp \u00b1 beard\/body) is sufficient.\n\nWhat we suggest\nWe recommend you book a 60-minute consultation with Dr. Hussain. During this, you'll receive:\n\n\u2022 A clear, personalised treatment plan\n\u2022 A more precise estimate of grafts for each stage\n\u2022 Guidance on what we can realistically achieve in the short and long term\n\nBest regards,\nMy Hair Clinic\n\nWhatsApp: +971 58 247 0065 | Email: info@myhairclinic.com\n\nDisclaimer: This is an automated estimate and not a medical decision. Final recommendations follow an individual consultation with Dr. Hussain.`;\n return { subject, body };\n }\n else {\n const body = `Hi ${patientName},\n\nThank you for using our graft calculator.\nYour estimated number of grafts is: ${estimates.total.min} \u2013 ${estimates.total.max}\n\nTo make sure you get the best, most natural outcome, we recommend you book a 60-minute consultation with Dr. Hussain. During this, you'll receive:\n\n\u2022 A clear, personalised treatment plan\n\u2022 A more precise estimate of how many grafts can be transplanted\n\u2022 Guidance on what we can aim for in the short and long term\n\nBest regards,\nMy Hair Clinic\n\nWhatsApp: +971 58 247 0065 | Email: info@myhairclinic.com\n\nDisclaimer: This is an automated estimate and not a medical decision. Final recommendations follow an individual consultation with Dr. Hussain.`;\n return { subject, body };\n }\n}\n\nfunction submitAssessment() {\n const errors = validateForm();\n if (errors.length > 0) {\n alert('Please complete the required fields:\\n' + errors.join('\\n'));\n return;\n }\n\n const selectedAreas = getSelectedAreas();\n const estimates = computeAreaRanges(selectedAreas);\n const recommendation = determineRecommendation();\n const assessmentData = buildAssessmentData(estimates, recommendation);\n\n const patientName = document.getElementById('patientName').value.trim();\n const patientAge = parseInt(document.getElementById('patientAge').value) || null;\n const emailMessage = buildEmailMessage(patientName, estimates, patientAge, selectedAreas);\n\n submitToCF7(assessmentData, emailMessage);\n}\n\nfunction getSelectedAreas() {\n const areas = [];\n \n const frontOption = document.querySelector('input[name=\"frontOption\"]:checked');\n if (frontOption) areas.push(frontOption.value);\n \n const crownOption = document.querySelector('input[name=\"crownOption\"]:checked');\n if (crownOption) areas.push(crownOption.value);\n \n return areas;\n}\n\nfunction computeAreaRanges(selectedAreas) {\n const estimates = {\n perArea: {},\n total: { min: 0, max: 0 }\n };\n \n selectedAreas.forEach(area => {\n if (CONFIG.areaRanges[area]) {\n const baseRange = CONFIG.areaRanges[area];\n estimates.perArea[area] = {\n min: baseRange.min,\n max: baseRange.max\n };\n \n estimates.total.min += baseRange.min;\n estimates.total.max += baseRange.max;\n }\n });\n \n return estimates;\n}\n\nfunction determineRecommendation() {\n const notLostEverything = document.getElementById('notLostEverything').value === 'true';\n const selectedAreas = getSelectedAreas();\n const hasCrown = selectedAreas.includes('crown');\n \n if (notLostEverything) {\n return {\n path: 'Medical Hair Restoration + Future FUE Consideration',\n notes: 'Based on assessment, recommend starting with Medical Hair Restoration to slow further hair loss. FUE can be considered later depending on response to treatment.'\n };\n } else if (hasCrown && selectedAreas.length > 1) {\n return {\n path: 'Comprehensive FUE Hair Transplantation',\n notes: 'Based on your selection of multiple areas including the crown, a comprehensive FUE procedure is recommended for full coverage and natural-looking results.'\n };\n } else {\n return {\n path: 'FUE Hair Transplantation',\n notes: 'Based on your selected areas, FUE (Follicular Unit Extraction) hair transplantation is recommended for natural-looking results with minimal scarring.'\n };\n }\n}\n\nfunction buildAssessmentData(estimates, recommendation) {\n const selectedAreas = getSelectedAreas();\n \n const areaNames = [];\n if (selectedAreas.includes('frontOnly')) areaNames.push('Front Hairline Only');\n if (selectedAreas.includes('frontTemples')) areaNames.push('Front Hairline + Temples');\n if (selectedAreas.includes('frontTemplesMid')) areaNames.push('Front Hairline + Temples + Mid-Scalp');\n if (selectedAreas.includes('crown')) areaNames.push('Crown');\n \n let areaEstimatesText = '';\n Object.keys(estimates.perArea).forEach(area => {\n const range = estimates.perArea[area];\n const areaName = getAreaDisplayName(area);\n areaEstimatesText += `${areaName}: ${range.min} - ${range.max} grafts\\n`;\n });\n \n return `HAIR RESTORATION ASSESSMENT\n===========================\n\nPATIENT INFORMATION:\nName: ${document.getElementById('patientName').value.trim()}\nEmail: ${document.getElementById('patientEmail').value.trim() || 'Not provided'}\nPhone: ${document.getElementById('patientPhone').value.trim() || 'Not provided'}\nAge: ${document.getElementById('patientAge').value || 'Not provided'}\nPreferred Location: ${document.getElementById('locationPreference').value || 'Not specified'}\n\nASSESSMENT DETAILS:\nAreas to Restore: ${areaNames.join(', ') || 'None selected'}\nPrior Surgery: ${document.querySelector('input[name=\"priorSurgery\"]:checked').value === 'true' ? 'Yes' : 'No'}\nStill Losing Hair: ${document.getElementById('notLostEverything').value === 'true' ? 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