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Post Surgery � Patient Disclaimer

Post Surgery � Patient Disclaimer

Patient�s Name:

File No.:

DOB:

Mobile Number:

Visit Date:

Registration Time:

Doctor Name:

Date:

I, , post surgery, am in healthy condition to travel back home and in my full senses. I am satisfied by the effort put by the team for my hair transplant surgery.

I had a full conversation with the hair transplant team about my surgery and I don�t have any complaints or any further points to add on.

I am convinced and happy with my frontal hair line along with the level of density, spread of grafts, number of grafts transplanted.

All post surgery instructions have been given to me by the team. I am have read and understood the Post Surgery protocols instructed by the Hair Transplant team. I will respect and follow instructions given to me.

Patient Name :
Patient Siganture:
Date of Surgery :

Patient Name & Signature :

Doctor/Therapist Name & Signature :

Witness Name & Signature :

Parent or Gaurdian Name (if patient is minor) :

Patient Name & Signature :