Medium

Available on

Apple Android Windows

Informed Consent For Scalp Micropigmentation Procedure Mobile App

The Informed Consent For Scalp Micropigmentation Procedure mobile app makes it easy to get consent for hair loss treatments that involve medical micropigmentation.

The scalp micropigmentation consent form covers the risks associated with the hair treatment , patient medical history, hair loss details, and patient consent. Once the hair treatment procedure consent form has been completed, the scalp micropigmentation consent form is saved for your records.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the Informed Consent For Scalp Micropigmentation Procedure Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

  • {{data.title}}

Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Name

  • Ico statictext

    I hereby request and consent to the application of Scalp Micro Pigmentation and consent to have t...

  • Ico statictext

  • Ico statictext

    Select The Following That Applies To You

  • Ico checkbox

    Alopecia

  • Ico checkbox

    SMP & FUE Combinations

  • Ico checkbox

    Hair Transplant Scars

  • Ico checkbox

    SMP Reparations

  • Ico checkbox

    Male Pattern Baldness

  • Ico checkbox

    Scar Camouflage

  • Ico checkbox

    SMP Follow UP

  • Ico checkbox

    Thinning Hair

  • Ico checkbox

    Long Hair

  • Ico textbox

    Other

  • Ico checkbox

    desired results.

  • Ico checkbox

    type, and age, and exposure to the sun, smoking, alcohol, medications.

  • Ico checkbox

    I recognize that my technician uses his/her experience and his/her professional advice is a natur...

  • Ico checkbox

    For education or assistance, I consent to the admittance of authorized observers to the procedure...

  • Ico checkbox

    I have received and acknowledged pre- and post-procedure instructions and agree to adhere to such...

  • Ico checkbox

    I accept responsibility for determining the color, shape and position the hairline the would be a...

  • Ico checkbox

    I agree that before and after photos of your treatment are required for our records.

  • Ico checkbox

    I have received and acknowledged post-procedure instructions and agree to adhere to such instruct...

  • Ico checkbox

    Any alterations or adjustments after the second session do not fall under the guarantee.

  • Ico checkbox

    I acknowledge that I have truthfully presented to the associates, proper identification that stat...

  • Ico statictext

    tenderness.

  • Ico signature

    Client

  • Ico date

    Date

  • Ico textbox

    Practitioner

  • ...and More!

Related Health Care & Social Services Apps... and they're all free for GoCanvas subscribers!

App Name

Hold Harmless Client Agreement

This is the Hold Harmless Client Agreement app. This app serves to inform the client and clearly lay out the limit of liab...

App Name

Hair Loss New Patient Information Sheet

This is the Hair Loss New Patient Information Sheet. This is a comprehensive app for anyone treating new patients for hair...

App Name

Esthetician Parental Consent Form (Ca...

The Esthetician Parental Consent Form (Canada) is a basic consent form template for parents or legal guardians of minors t...

App Name

Esthetician Client Consent Form (Canada)

The Esthetician Client Consent Form (Canada) is a simple consent template to be used by estheticians prior to a procedure ...

App Name

Electrologist Complaint Form

Use the Electrologist Complaint Form mobile app to complete this complaint from using a mobile device. This app generates ...

App Name

Protocols Clinical Electrology

The Protocols Clinical Electrology mobile app provides a detailed protocols checklist for Clinical Electrology and Laser P...

App Name

MedSpa Client Information and Medical...

The Spa Client Information and Medical History mobile app is used collect client information and their medical history pri...

App Name

Client Record, Consent and Electrolog...

The Client Record, Consent and Electrology Aftercare mobile app provides a simple way for electrologists to provide helpfu...

More Information