Electronic Receipt

Acceptance of these terms is under the supervision of a Hairitige consult professional. To complete a sample treatment or consultation, complete the acceptance checkpoints below.

Health History

Please choose Yes or No if you've had a history with any of the mentioned health items. Please provide details where indicated.

Photo Consent

The Hairitige™ process will take before and after photos or videos of your scalp and hair for documentation, education, and treatment purposes. Electing to authorize marketing usage in this step will allow Hairitige™ to use progress and treatment images for marketing purposes.

Please understand:
Your identity will be protected. Marketing photos may be shared with you electronically at your request.

Treatment Consent

I hereby consent to receive hairitige™ treatments, including hair restoration procedures, exosome therapy, and related aesthetic treatments. I acknowledge that:
- My provider has explained the purpose, expected benefits, limitations, and alternatives.
- No guarantees have been made regarding results; outcomes vary by individual.
- Risks and possible side effects include local irritation, swelling, redness, infection, allergic reaction, and suboptimal results.
- I am voluntarily participating and may discontinue treatment at any time.

I understand that follow-up and maintenance sessions may be recommended for optimal results.

Financial Responsibility & Acknowledgement

I understand that hairitige™ treatments are elective and not covered by insurance.
I acknowledge full financial responsibility for all treatments and maintenance sessions.
All fees are non-refundable.
I understand the estimated costs of today’s treatment and any recommended follow-ups.

Treatment Instructions: Before and After

Risks & Complications

Pain or discomfort: minimal if any and temporary, may vary by individual.
Swelling or redness: typically resolves in 1–3 hours.
Infection: rare, but scalp hygiene must be maintained.
Allergic reactions: possible to products.