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PRP Treatment Consent

Consent For Use Of PRP Treatment Cosmetics

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I understand that the procedure will involve injecting the scalp or face with plasma collected on the day of injection.

I understand that platelet rich plasma is not a currently medically accepted procedure for testing or treating alopecia and, thus, its use for this purpose may be considered by some insurance companies to be “medically unnecessary” or “experimental”.

The procedure has some risks. Diamond Clinic has explained to me verbally the short and long-term risks, which may include temporary worsening of my current symptoms or headache, tachycardia (increased heart rate), syncope (fainting), visual difficulties or shortness of breath.

By signing this form, I accept those risks. Moreover, I understand and accept that because this procedure may be considered “medically unnecessary” or “experimental”, it may not mitigate, alleviate, or cure my condition (s). Its possible benefits may not be apparent immediately. The possible benefits include increased hair growth on the scalp resulting in increased hair thickness & texture.

I understand the nature of the treatment, which has been explained to me by Diamond Clinic.

Platelet-rich plasma (PRP). PRP has both proliferation-inducing as well as anti-inflammatory effects. A small randomized, double-blind, placebo- and active-controlled, half-head study has shown PRP to be superior to both intra-lesional triamcinolone acetonide and placebo1. While showing promise, more studies are needed.

I understand that the currently “standard” medically indicated treatment(s) for my condition is/are For alopecia areata:
- no treatment, d/t benign nature of condition
- topical immunotherapy: quaric acid dibutylester (SADBE) and diphencyprone (DPCP), intralesional interferon alfa-2
- intralesional injected steroid medications (triamcinolone acetonide )
- topical steroid creams: betamethasone dipropionate cream 0.05%, fluocinolone acetonide cream 0.2%, minoxidil 1%
- psoralen plus UV-A (PUVA)
- rx medications: prednisone, cyclosporine, Anthralin, prostaglandin analogues, Dapsone, methotrexate, Simvastatin/ezetimibe, biological agents
- stem cell therapy
- zinc

For Androgenic Alopecia:
- prescription medications: minoxidil, finasteride, dutasteride, topical latanoprost 0.1%
- low-level laser light therapy
- adipose-derived stem cells
- Serena repens extract
- surgical care: fractional erbium-glass laser



Today's date: 15/02/2025

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Treatments at Diamond Clinic

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PRP Treatment Therapy

PRP (Platelet-Rich Plasma) therapy is a revolutionary treatment that utilizes your body's own blood to rejuvenate your skin and promote hair regrowth.
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Dermal Fillers

Enhance your natural beauty and restore youthful volume with our dermal filler treatments. Our expert injectors use premium dermal fillers to address various concerns.
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Anti-Wrinkle Treatments

Combat the signs of ageing and achieve smoother, more youthful-looking skin with our anti-wrinkle treatments.

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Vitamin B12 Injections

Boost your energy levels and promote overall well-being with our Vitamin B12 injections. Experience increased vitality and improved mood with this essential vitamin supplement.
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Dissolve Hyaluronic Acid

In the rare event of dissatisfaction or complications from previous dermal filler treatments, our Dissolve Hyaluronic Acid treatment can help.