Consent for treatment
I am being evaluated by The Primping Place and understand I will first undergo a comprehensive preliminary evaluation by one of our experienced hair loss consultants and may talk to a doctor should I need a prescription product. This evaluation will determine if I am a suitable candidate for treatment prior to having my chart reviewed by a physician. I understand that the cost of the initial evaluation is FREE and The Primping Place has waived its $250 consultation fee. This preliminary evaluation will include a complete and thorough medical and hair loss questionnaire, a scalp evaluation if available which includes standard medical photography (no face shown), and microscopic photography for which I give consent. I also understand that although HLCC/ XTC™ has had many extremely successful clients, each client is different and like any medical or cosmetic treatment results will vary depending on a large number of factors. I acknowledge that it is my responsibility to inform The Primping Place of any changes in my medical condition no matter how slight and agree to read all product labels and treatment information provided to me so I can understand my treatments and get the best possible results.
I understand some general recommendations will be made based on the initial consultation and if it is determined that I am a candidate for a prescription treatment program; an appointment will be made with one of the clinic’s doctors. I also understand it is my responsibility to keep my appointment with the doctor.
Please give us a 4 hour notice or you will be charged a $25 no-show fee.
Today's Date: December 13, 2018