Hair Rejuvenation Center

Hair Loss Questionnaire

By providing my phone number, I agree to receive text messages from the business.

Females only - click NEXT if male

Male Only - Click NEXT if Female

Consent for treatment

I agree to being evaluated and I understand I will first undergo a comprehensive preliminary evaluation by an experienced consultant. All other checkups are included with the cost of the program, which include monthly and/or quarterly digital and microscopic pictures, for which I give my consent. I further understand results will vary depending on a large number of factors. I acknowledge that it is my responsibility to the company of any changes in my condition, no matter how slight.

I understand some general recommendations will be made based on the initial consultation.

Clear