Informed Consent for Telehealth Treatment

1. What Informed Consent Means

Informed consent is your right — and our obligation. Before you receive any prescription or treatment recommendation from Hair Scripts, you are entitled to understand what we propose to do, why, what the risks and benefits are, what the alternatives are, and that you may refuse or withdraw at any time without penalty.

By submitting your intake form, you confirm that you have read this document, had the opportunity to ask questions, and voluntarily consent to the telehealth consultation and any prescription issued as a result.

2. Nature of the Telehealth Consultation

Hair Scripts provides asynchronous telehealth consultations. This means:

• —You submit an intake questionnaire and photographs of your scalp and hair loss pattern.
• —A licensed clinician reviews your submission and, where appropriate, issues a prescription or treatment recommendation.
• —Follow-up may occur by phone, video, or secure message — not necessarily in real time.

This is not a traditional in-person clinical encounter. There are inherent limitations to remote assessment, including the inability to perform a physical examination. If your clinician determines that your condition requires in-person evaluation, they will inform you and decline to prescribe until appropriate in-person care has been obtained.

Hair Scripts prescribes to patients located in the 48 contiguous U.S. states and Washington, D.C. By using this service, you confirm that you are physically located in a state we serve at the time of your consultation.

3. Risks of Compounded Medications

Hair Scripts prescribes compounded medications prepared by state-licensed compounding pharmacies. You should understand the following before starting treatment:

Compounded medications are NOT FDA-approved.

They are prepared based on a licensed clinician's prescription for your individual needs, but they have not undergone the FDA's drug approval process for safety and efficacy.

Topical treatments (minoxidil-based serums):

• —Common side effects include scalp irritation, dryness, itching, or flaking at the application site.
• —An initial shedding phase (telogen effluvium) is common in the first 4–8 weeks and does not indicate treatment failure.
• —Systemic absorption is possible with topical minoxidil; if you experience chest pain, rapid heartbeat, dizziness, or swelling of face/hands, discontinue use and seek medical attention.

Oral minoxidil:

• —Low-dose oral minoxidil (typically 0.625–2.5mg daily for women; 2.5–5mg for men) carries cardiovascular risks including fluid retention and changes in heart rate.
• —Not appropriate for individuals with certain cardiovascular conditions. Disclose all medical history accurately.

Finasteride and dutasteride:

• —These 5-alpha reductase inhibitors are contraindicated in pregnancy and in women who may become pregnant. Finasteride and dutasteride can cause birth defects in male fetuses. Women of childbearing potential must use reliable contraception and must not handle crushed or broken tablets.
• —Side effects may include decreased libido, sexual dysfunction, and mood changes. A small percentage of users report post-finasteride syndrome; discuss this with your clinician.
• —Dutasteride has a longer half-life than finasteride and remains in the system for up to 6 months after discontinuation.

All treatments:

• —Results are not guaranteed. Individual response varies based on genetics, underlying cause of hair loss, and other factors.

4. SULT1A1 Test Limitations

The Hair Scripts Response Test measures SULT1A1 sulfotransferase enzyme activity as a predictor of minoxidil response. You should understand:

• —The test is predictive, not diagnostic. A positive result increases the probability of response to minoxidil; it does not guarantee it.
• —False positives and false negatives are possible. Enzyme activity can vary by time of day, scalp health, and other factors.
• —A negative result does not mean hair loss treatment will fail — alternative therapies may still be appropriate.
• —This test does not diagnose the cause of your hair loss. A complete workup may require bloodwork, biopsy, or other investigations outside the scope of this service.

5. Alternatives to Treatment

You have the right to choose not to pursue treatment or to pursue alternatives, including:

• —No treatment (watchful waiting)
• —Over-the-counter topical minoxidil (Rogaine or generic, 2% or 5%)
• —In-person evaluation by a board-certified dermatologist or trichologist
• —Platelet-rich plasma (PRP) therapy
• —Hair transplant surgery
• —Nutritional or lifestyle interventions

Your clinician can discuss the relative merits of these alternatives with you.

6. Expected Timeline and Realistic Outcomes

Hair restoration is a slow process. Typical timelines with treatment:

• —2–3 months: Reduction in shedding; the hair loss phase stabilizes.
• —4–6+ months: Visible new growth may become noticeable.
• —12+ months: Full evaluation of treatment efficacy.

Not all patients will see regrowth. Stabilization of hair loss is a clinically meaningful outcome. If you are not responding to treatment after 6 months, your clinician will review your plan.

7. Right to Refuse or Withdraw Consent

You may refuse treatment or withdraw consent at any time, for any reason, without penalty or impact on your access to care. To withdraw consent and cancel your treatment plan, contact us at info@hair-script.com or call (480) 222-0483.

Withdrawal does not automatically cancel a prescription already sent to the pharmacy. Contact us promptly if you wish to halt a pending prescription.

8. Privacy and HIPAA

Your health information is protected under the Health Insurance Portability and Accountability Act (HIPAA). Hair Scripts maintains HIPAA-compliant systems and does not sell your health information. For full details, see our Privacy Policy.

9. Arizona-Specific Telehealth Notice

Hair Scripts operates under Arizona's telehealth statutes. Telehealth services in Arizona are subject to the same standard of care as in-person services. If you have concerns about the care you received, you may contact:

10. Patient Acknowledgment

By submitting your intake, you acknowledge that you have read, understood, and agreed to this informed consent.