INFORMED CONSENT FOR HAIR LOSS TREATMENTS AND MEDICATIONS

Including Compounded Prescriptions | Male and Female Pattern Hair Loss | General Thinning and Alopecia Support


Nationwide Applicability | California Compliant | Telehealth Enabled


PLEASE READ THIS DOCUMENT CAREFULLY


1. Overview of Hair Loss Treatment

You are being evaluated for a medical treatment plan intended to address hair loss, thinning hair, or scalp-related conditions. Treatment may include:
– Prescription topical or oral medications
– Customized compounded formulations
– Nutritional or supplement-based support
– Hormonal modulation or blockers
– Behavioral and lifestyle recommendations


Your treatment plan will be tailored to your clinical presentation, lab results (if applicable), and treatment goals.


2. Medications That May Be Prescribed

The following medications and agents may be prescribed:
– Finasteride (topical or oral)
– Dutasteride
– Minoxidil (topical or oral)
– Spironolactone
– Biotin, zinc, and vitamin-based supplements
– Compounded hair serums or capsules
– Peptides (e.g., GHK-Cu, PTD-DBM)
– Ketoconazole or other antifungal shampoos


These medications may assist in slowing hair loss, stimulating regrowth, or supporting follicular health.


3. Disclosure Regarding Compounded Medications

Some prescriptions may be compounded medications, custom-formulated to meet your specific needs and prepared by licensed U.S. compounding pharmacies.


Please be advised:

– Compounded medications are not reviewed or approved by the FDA.
– These formulations are prepared under the direction of your licensed provider.
– All compounding pharmacies used by DrWell are licensed and meet applicable state and federal standards.
– DrWell is LegitScript certified, ensuring adherence to legal and safety standards in telehealth and pharmacy care.


4. Off-Label Use Disclosure

Some medications used in hair loss treatment may be prescribed for uses not specifically approved by the FDA. This is known as off-label use, and it is legal, common, and based on emerging clinical evidence or provider experience.


Your provider will recommend such therapies only when clinically appropriate and will explain their intended use, risks, and rationale.


5. Potential Risks and Side Effects

Possible side effects vary by medication and may include:
– Scalp irritation or dryness
– Dizziness or fatigue
– Hormonal side effects (e.g., decreased libido with finasteride)
– Breast tenderness (e.g., with spironolactone)
– Allergic reactions
– Hair shedding during early phases of treatment


You will be monitored as needed, and any unusual or adverse symptoms should be reported immediately to your provider.


6. No Guarantees or Promises

While many patients benefit from hair loss treatments, results may vary by individual. No guarantee can be made regarding the speed, amount, or permanence of hair regrowth.


Success depends on your biology, consistency in following treatment instructions, and other health and lifestyle factors.


7. Telehealth Services and Consent

Treatment may be delivered via telehealth, including secure video consultation or asynchronous provider review.


You agree that:

– The treating provider is licensed in the state where you are located at the time of service.
– Your privacy is protected under HIPAA and relevant telehealth laws.


California Residents (Business & Professions Code § 2290.5):

– You have the right to decline or withdraw telehealth consent at any time.
– Your rights to in-person care and informed decision-making remain protected.


8. Treatment Availability by State

DrWell providers are licensed nationwide; however, availability of specific medications—especially compounded treatments—may vary by state regulations.


All prescriptions require a proper clinical consultation via video or asynchronous telehealth review. Some medications may be modified or denied based on medical necessity or local law.


9. Patient Responsibilities

As a patient, you agree to:
– Disclose all relevant medical history and current medications
– Adhere to treatment protocols as directed
– Monitor and report any side effects
– Maintain communication with your provider


Failure to follow instructions or conceal medical information may affect safety and outcomes.


10. More Information & Support

For additional safety information or to speak with your provider, contact the DrWell support team.


You may also visit:
https://www.drwell.com/patient-resources

 

By proceeding with treatment, you acknowledge that you have read and understood this Informed Consent. You accept the risks and responsibilities outlined and consent to receive hair loss treatments and medications as prescribed by a licensed DrWell provider.