Please fill out this form for your practice to be included on the Find A Physician Tool.

  • Physician / Office Photo 1
  • By clicking "Submit" below, I hereby consent and give to Restoration Robotics, Inc. (the "Company"), and to its agents, legal representatives, assigns, licensees and those acting with Company’s permission or under Company’s authority (collectively "Assigns") the worldwide, royalty-free, and unrestricted right and permission to use, reproduce, publish, republish, distribute and publicly display: (a) all photographs or images ("Images") provided by me on this web portal for any lawful purpose without restriction, including publication on Company’s websites; and (b) the information provided by me regarding me and my practice, in a form that is substantially similar so long as the intent and substance of the information remains the same. I agree and understand that I may, at any time, request that Company remove such Images or the description of me or my practice, and that Company will take all reasonable efforts to promptly remove the Images or description.