Online Consultation & Treatment Consent

DR HAIR CLINIC

I voluntarily request and consent to an online (telephonic / video / digital) consultation with DR HAIR CLINIC.

I understand and agree to the following:

1. Nature of Online Consultation

I understand that online consultation has inherent limitations, including lack of physical examination, and is based solely on:

Medical history provided by me
Photographs / videos uploaded by me
Information shared during consultation

2. Accuracy of Information

I confirm that all medical information, history, images, and details provided by me are true and complete. Incorrect or concealed information may affect diagnosis and outcomes.

3. Treatment Outcomes

Results vary between individuals
No guarantee of cure or regrowth
Depends on biological, genetic, hormonal, and lifestyle factors

4. Medicines & Side Effects

Prescribed medicines or procedures may have side effects or limitations as explained or available in standard medical literature.

A. Oral Minoxidil Consent

I understand that oral minoxidil is prescribed off-label and may cause:

Increased heart rate
Swelling of feet / face
Dizziness or headache
Low blood pressure
Excess body hair growth

☑️ I consent to Oral Minoxidil if prescribed.

B. Finasteride / Dutasteride Consent

These medicines may cause:

Reduced libido
Erectile dysfunction
Ejaculatory changes
Mood changes (rare)

These are contraindicated in pregnancy and should not be handled by female patients if crushed.

☑️ I consent to Finasteride / Dutasteride if prescribed.

5. Follow-Up & Compliance

Treatment success depends on regular usage, follow-ups, and adherence to medical advice.

6. Emergency & Physical Examination

Online consultation is not suitable for emergencies. I may be advised to visit physically if required.

7. Refund & Legal Claims

Online consultation does not guarantee refund unless covered under clinic policy.

8. Consent & Authorization

I give my free and informed consent for online consultation and authorize digital record maintenance.

☑️ I have read, understood, and agree to the above terms.

☑️ I consent to online consultation and treatment advice.

Patient Name: ____________________

Date: ____________________

☑️ I confirm that I am 18 years or older or consulting under guardian consent.

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