Self Assessment
Choose Consent Form
HTP Weak Donor Area Consent

Hair Transplant Weak Donor Area Consent

Patient’s Name:

File No.:

DOB:

Mobile Number:

Visit Date:

Registration Time:

Doctor Name:

I, visited the for a Hair Transplant procedure.

Hereby acknowledge that I am aware of the weakness in my donor area for the hair transplant procedure, and I understand that some mild gaps may form.

I fully comprehend the potential outcomes and am prepared to proceed with the treatment.

Patient Name & Signature :

Doctor/Therapist Name & Signature :

Witness Name & Signature :

Parent or Gaurdian Name (if patient is minor) :

Patient Name & Signature :