Full Name: *

Date of Birth: *

Procedure Date: *

Introduction

Platelet-Rich Plasma (PRP) therapy is a non-surgical treatment for hair loss that involves using your own blood to stimulate hair growth. The process includes drawing a small amount of your blood, processing it to concentrate the platelets, and then injecting the PRP into the scalp to promote hair follicle rejuvenation and stimulate new hair growth.

Procedure

The procedure begins with drawing a small sample of your blood, which is then processed in a centrifuge to isolate the platelet-rich plasma. The PRP is then injected into areas of the scalp where hair thinning or hair loss is present. The process typically takes about 30 to 60 minutes.

Potential Risks & Side Effects

I understand that, as with any medical procedure, there are potential risks and side effects, including but not limited to: *

Pain, swelling, or tenderness at the injection site

Redness or minor bruising

Infection (though rare)

Temporary hair shedding (which may occur before new growth starts)

Allergic reactions (though rare)

Scalp discomfort or itching

Pre-Treatment Instructions *

Avoid blood-thinning medications such as aspirin, ibuprofen, or certain supplements (e.g., fish oil, vitamin E) for at least 7 days before the procedure unless medically necessary.

Avoid alcohol for at least 24 hours before treatment.

Inform the practitioner of any current medications, blood disorders, or skin conditions (such as psoriasis or dermatitis) that could affect treatment.

Ensure that your scalp is clean and free from any products, including oils, sprays, or hair gels, on the day of treatment.

Post-Treatment Care *

Avoid touching, massaging, or applying pressure to the treated area for 24 hours.

Avoid vigorous physical activity, hot tubs, saunas, and swimming for 24-48 hours post-treatment.

Avoid direct sun exposure to the treated areas and apply sunscreen if necessary.

Do not wash your hair or use any hair products for at least 24 hours after the treatment.

Follow any additional aftercare instructions provided by the practitioner.

Acknowledgment & Consent *

I have read and understand the information provided regarding PRP hair loss treatment. I have had the opportunity to ask questions and all my concerns have been addressed. I acknowledge the potential risks and benefits of the treatment and consent to proceed with the procedure.

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