Several skin conditions can affect your scalp and make you lose hair. Suppose your scalp is itchy, inflamed, or painful, and you’ve noticed more hair shedding than usual. In that case, it’s essential to take action as quickly as possible to work out what’s causing your scalp issues and what you can do to treat and improve your skin.
While not all instances of scalp inflammation result in hair loss, certain medical conditions that induce scalp inflammation may also cause injury to hair follicles, thereby inducing hair loss. However, failure to address the inflammation may lead to permanent hair loss due to injury to the hair follicles in the scalp. Further conditions that induce inflammation, especially those that induce itching, may indirectly contribute to hair loss by causing damage to the scalp and follicles through scratching.
- Scalp Exam
- Hair Treatment
- Scalp Treatment
- Scalp Mask
- Scalp Massage
- 30 Day nutritional supplement
- 1 Take Home Peptide Spray
- We offer financing
*After just 1 treatment, patients reported improvement in scalp itchiness, scalp dryness, scalp flakiness and hair fullness.
• Your scalp may experience temporary irritation, tightness, or redness. These are all normal reactions that typically resolve within 72 hours, depending on scalp sensitivity. In the event that these reactions occur, discontinue use of the take-home spray until they are resolved.
• You may experience slight tingling and/or stinging in the treatment area. These sensations generally
subside within a few hours.
• Do not use aggressive exfoliation, scrubs etc one week prior to treatment and one week post treatment.
• Client experiences may vary. Some clients may experience a delayed onset of symptoms.
• The scalp can be susceptible to sunburn/sun damage. Always avoid excessive sun exposure. We
recommend using a minimum of SPF 30 sunscreen, protective clothing and accessories when exposed to the sun.
Do you have any of the following?
If you answer yes to any of the health questions below, you are unable to have treatment at this time!
• An autoimmune disease such as HIV, lupus, hepatitis, scleroderm
• Scalp conditions such as active eczema, dermatitis, or rashes
• An active infection in the treatment area
• Melanoma or lesions suspected of malignancy
• Active sunburn
• Pregnancy or lactation
• Anticoagulants Therapy
• Neurological disorders such as epilepsy
• Infection in the urinary system including kidneys, bladder and urethra
• Crohn’s Disease
• Hyperthyroidism
• Deep Venous Thrombosis
• Lymphedema
• Open lesion
• Active Acne/Inflammatory Acne
HydraFacial™ Keravive™
Treatment Consent Form
HydraFacial Keravive is a unique, relaxing treatment designed to cleanse, nourish, and hydrate the scalp for fuller and healthier−looking hair. As with most procedures, visible results from HydraFacial Keravive will vary from person to person.
Precautions:
Answering yes does not disqualify you from treatment!
Have you recently?
• Used Minoxidil (Rogaine) or similar topical medications or non−medical treatments
• Color−treated your hair or added extensions
• Used Propecia or any other medications or supplements
• Received a PRP treatment or hair transplant
I acknowledge the following:
• Photos may be taken before, during and after the HydraFacial Keravive treatment. Photos will only be used with my written approval for education, promotion or advertising purposes.
• The information provided has been explained to me and all my questions have been answered to my
satisfaction. I have read the above information, and I give my consent to have the HydraFacial Keravive treatment by the staff at Confluence Hair and Scalp Salon.
• By signing below, I acknowledge that I have read the above information and give my consent to be
treated with the HydraFacial System. This consent form Is valid for all future HydraFacial Keravive
treatments. I will alert the staff if there are any future changes to my medical history.
Print Name: Signature: Date:
HydraFacial™ Keravive™
Treatment Consent Form
