Trichology Consultation and Consent
Emergency Contact Details
If possible, please upload clear photos of your hair loss to help us be better prepared for your appointment.
I accept that any treatment I am going to receive is at my own risk.
I certify that I have read, fully understood, and completed this form to the best of my knowledge.
I understand that failure to disclose information requested above may result in adverse side effect(s), unknown because of this to which I accept full liability/responsibility.
The treatment(s) and possible side effect(s) have been fully explained to me.
I accept full responsibility for the treatment given and complications which may arise or result during or following any procedure that is performed at my request.
I accept that if I am not satisfied with the treatment I will inform the therapist and/or request to speak to the manager during, or immediately following, the treatment.
I fully understand the above and consent to the Trichology treatment(s) to be carried out.
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