Your hair rejuvenated

Contact us to complete an intake consultation and build a service plan with our experts.

Tampa Location

4830 West Kennedy Blvd. STE. 106

Tampa, Florida 33609

Sarasota Location

101 S. Pineapple Ave., Image Studio 118

Sarasota, Florida 34236

Select your closest location for treatment:

Hair Status (check all that apply)

People of all hair conditions can benefit from Hairitige's exosome application. Please do not hesitate to reach out to us with any questions.

General Contact

4830 West Kennedy Blvd. STE. 106

Tampa, Florida 33609

Ready to begin your Hairitige regrowth journey?

Fill out our patient profile form below to schedule an intake appointment with one of our professionals.

*NOTE* Hairitige currently has physical locations in Tampa Bay and Sarasota. Additional franchises will be opening across the United States soon.
1
Intake Info
2
E-Receipt
3
Medical History
4
Photo Consent
5
Treatment Consent
6
Finanacial Responsibility
7
Treatment Instructions
8
Last Page

Contact Information

Please select your current or nearest intake location:
Name
Date of Birth
Email
Phone
Address
City
State
ZIP Code
Emergency Contact Name
Emergency Contact Phone

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.

Electronic Receipt Acceptance

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.

History of MRSA
Details | Date of Diagnosis
Abnormal Heart Condition
Details | Date of Diagnosis
Diabetes
Details | Date of Diagnosis
Cancer
Details | Date of Diagnosis
Chemotherapy/Radiation
Details | Date of Diagnosis
Autoimmune Disorder
Details | Date of Diagnosis
Blood Thinners/Anticoagulants
Details | Date of Diagnosis

Are you currently on any medications? Please indicate below:

Medications

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.

Hairitige Photo Consent *

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.

Treatment Consent *

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.

Financial Responsibility & Acknowledgement *

Treatment Instructions: Before and After

Pre-Treatment Instructions

Do not wash hair or apply products for 24 hours.
Follow the aftercare card and instructions provided.
Avoid sun exposure, swimming, or harsh chemicals for at least 14 days.
Use gentle hair care products as directed.
Contact hairitige™ if unusual swelling, redness, or irritation occurs.

Pre-Treatment Instructions *

Post-Treatment Instructions

Do not wash hair or apply products for 24 hours.
Follow the aftercare card and instructions provided.
Avoid sun exposure, swimming, or harsh chemicals for at least 14 days.
Use gentle hair care products as directed.
Contact hairitige™ if unusual swelling, redness, or irritation occurs.

Post-Treatment Instructions *

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.

Risks & Complications *