Consultation Form Name(Required) Phone(Required) Email(Required) Address(Required)Occupation(Required) Date of Birth MM slash DD slash YYYY Age Gender Special Interests Physical Fitness Sports Travel How often would you attend training, gym or other physical activity per week(Required) How long have you been suffering from hair loss?(Required) Has it happened suddenly and are using losing much hair?(Required) Do you have any relatives that suffer from hair loss?(Required) Yes No Have you used any treatments for hair loss? Yes No Please specify treatment used(Required) Have you ever had an allergic reaction to treatments?(Required) A Patch Test is required for all relevant treatmentsHave you any medical conditions?(Required) Yes No Please explain you medical conditions(Required) Current/Recent Medications(Required) I declare the above information to be true, knowing my provider relies on this information to provide safe and effective treatment(Required) I consent to the above statement Ticking the above box is the equivalent of a digital signature Disclaimer Important Information Mesh hair integration is a non-surgical hair replacement system. While it can provide a natural appearance and improved confidence, it requires ongoing maintenance and care. Please read the following carefully before proceeding. 1. Nature of Treatment Mesh hair integration involves attaching a mesh system to existing hair or scalp using various methods (e.g., braiding, bonding, sewing, or micro-rings). The system is semi-permanent and will require regular adjustments and upkeep. 2. Possible Risks & Considerations By signing this form, I acknowledge that I have been informed of the following: The system may cause tension, itching, or discomfort on the scalp. Prolonged or improper wear may result in hair breakage, thinning, or traction alopecia. Allergic reactions to adhesives, tapes, or materials are possible. The system requires regular maintenance (typically every 4–6 weeks) to prevent damage to natural hair and scalp. Failure to follow aftercare instructions may lead to damage or reduced longevity of the system. Results may vary depending on my natural hair condition, lifestyle, and adherence to care guidelines. 3. Maintenance & Aftercare I understand that professional maintenance appointments are essential. I have been advised of correct aftercare, including washing, drying, and styling methods. I accept that damage caused by neglect, misuse, or failure to follow guidance is not the responsibility of the stylist/technician. 4. Limitations Mesh integration is not a cure for hair loss. It may not be suitable for individuals with certain scalp conditions (e.g., psoriasis, eczema, infections). The system must be removed and re-applied by a trained professional only. Client Consent I confirm that: I have disclosed all relevant medical conditions, allergies, or scalp sensitivities to my stylist/technician. I have read and understood the information above, and all my questions have been answered. I understand the risks, maintenance requirements, and limitations of mesh hair integration. I release the stylist/technician and salon/clinic from any liability for adverse effects arising from this treatment, provided that professional standards and aftercare instructions are followed.Tick the box below to confirm you have read and you understand the above disclaimer(Required) I consent to the above statement Ticking the above box is the equivalent of a digital signature Robot check done automatically
