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Consent for FUE - Bernstein Medical

Consent for FUE - Bernstein Medical 2026

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The document outlines the Platelet Rich Plasma (PRP) treatment for hair loss offered by Bernstein Medical. It describes the procedure, which involves drawing a small amount of blood from the patient, processing it to extract PRP, and injecting it into thinning areas of the scalp to stimulate hair growth. The treatment schedule includes multiple sessions over several months, with indications and contraindications listed. It also details potential risks and complications, consent requirements, and financial responsibilities associated with the elective procedure.

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Click ‘Get Form’ to open the Consent for FUE - Bernstein Medical in the editor.
Begin by entering your personal information in the designated fields, including your last name and first name. Ensure accuracy as this information is crucial for your medical records.
Review the section regarding the use of anesthetics. Initial next to the appropriate statement that reflects your allergy status to local anesthetics.
Carefully read through the consent section. This outlines your understanding of the procedure, its risks, and financial responsibilities. Make sure all your questions are answered before proceeding.
Sign and date the form at the bottom where indicated. This confirms your voluntary consent for the PRP procedure.
If required, have your physician sign and date the form as well, ensuring all necessary approvals are documented.

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