Informed Consent for Platelet-Rich Plasma (PRP) – Skin & Hair Biostimulation

This consent form confirms that I have been fully informed and educated regarding Platelet-Rich Plasma (PRP) treatment for skin and/or hair restoration and rejuvenation, including its purpose, mechanism of action, methods of application (injectable and/or topical), expected benefits, limitations, alternatives, risks, and possible complications. I acknowledge that I have received sufficient information to make a voluntary and informed decision regarding treatment.

Nature of PRP

• I understand that PRP is an autologous concentration of my own platelets suspended in a small volume of plasma and contains a high concentration of growth factors and signaling proteins.
• I understand that PRP functions as a biostimulatory treatment, meaning it stimulates the body’s natural regenerative processes such as angiogenesis, cellular signaling, and tissue remodeling, rather than providing immediate structural correction.

Blood Collection & Processing

• I understand that this treatment involves the collection of approximately 15–30 mL of my blood using a needle and blood collection device.
• I understand that my blood will be processed using a centrifuge to separate blood components and that the platelet-rich plasma portion will be isolated and prepared for use.

Methods of Application

• I understand that PRP may be administered by injection into the scalp or skin and/or applied topically to the skin or scalp.
• I understand that topical PRP application is often combined with microneedling or other device-assisted treatments to enhance absorption.
• I understand that the method of application will be determined based on my treatment goals, anatomy, and my provider’s clinical judgment.

PRP for Hair Biostimulation

• I understand that PRP for hair restoration is intended to support follicular health, improve the scalp environment, and stimulate hair growth in appropriate candidates.
• I understand that PRP is not a replacement for hair transplant surgery or other surgical hair restoration procedures.
• I understand that although some improvement may be seen after the first treatment, a series of treatments is typically required for optimal results, often performed every 4–6 weeks initially, followed by maintenance treatments, commonly on a quarterly basis.

PRP for Skin Biostimulation

• I understand that PRP for skin rejuvenation is intended to improve skin quality, including texture, tone, thickness, and overall appearance, by stimulating collagen production and tissue repair.
• I understand that PRP does not restore volume and does not function as a dermal filler.
• I understand that additional treatments, such as hyaluronic acid fillers, other biostimulators, or energy-based devices, may be required for volume restoration or structural correction.

Treatment Variability & Expectations

• I understand that results may vary due to differences in platelet concentration, growth factor content, and individual biology.
• I understand that medicine is not an exact science and that no guarantees can be made regarding treatment outcome, degree of improvement, or duration of results.
• I understand that multiple sessions may be required to achieve and maintain desired results and that additional treatments may be necessary.

Alternatives to PRP

• I understand that alternatives to PRP may include topical therapies, oral medications, supplements, injectable treatments, energy-based devices, surgical procedures, or no treatment at all.
• I acknowledge that these alternatives have been discussed with my provider and that I have had the opportunity to ask questions.

Medical Disclosure & Contraindications

• I agree to fully disclose all medical conditions, allergies, and current medications or supplements.
• I deny having conditions that may be contraindications to PRP treatment, including but not limited to active or untreated cancer, systemic cancer or chemotherapy, chronic steroid therapy, blood disorders or platelet dysfunction, anticoagulation therapy, active local infection, certain inflammatory or scarring alopecias, and untreated thyroid disorders, anemia, PCOS, or hyperandrogen syndromes.
• I deny that I am currently pregnant, attempting to become pregnant, or breastfeeding. I understand that the safety of PRP during pregnancy and breastfeeding has not been established. If uncertain, I will request pregnancy testing prior to treatment.

Risks & Possible Complications

I understand that PRP treatments involve risks, including but not limited to:

• Discomfort or pain during treatment
• Swelling or tenderness
• Redness or irritation
• Bruising or bleeding
• Pigment changes, which are usually temporary
• Infection (rare)
• Delayed wound healing
• Scarring (rare)
• Allergic reaction to topical products or materials used
• Unknown or unforeseen side effects

I understand that individual responses vary and that delayed reactions may occur.

Post-Treatment Responsibility

I agree to promptly notify AI Wellness Center of Excellence if I experience any unusual, worsening, or concerning symptoms and to allow the clinic the opportunity to evaluate and participate in my care.

Authorization & Provider Qualifications

• I hereby authorize Dr. Gideon Kwok, D.O., and/or trained and qualified licensed medical providers acting within their scope of practice to perform PRP procedures, including injectable and/or topical applications.
• I acknowledge that I have had the opportunity to inquire about the qualifications and experience of the provider administering my treatment and that I am satisfied.
• I affirm that my consent is voluntary, informed, and freely given.

Final Acknowledgment

I acknowledge that I have read and fully understand this consent form, that all disclosures have been explained to me, that I have had the opportunity to ask questions, and that this form supersedes any prior verbal or written disclosures. I freely consent to Platelet-Rich Plasma (PRP) treatment for skin and/or hair biostimulation.