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Consent Form

Please complete this consent form before your PRP Therapy (Platelet-Rich Plasma / Vampire Facial) appointment. Once you sign, a copy is emailed to you and to Gemma automatically.

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PRP Therapy (Platelet-Rich Plasma / Vampire Facial) — treatment information & disclaimer

Platelet-Rich Plasma (PRP) therapy involves drawing a small sample of your own blood (phlebotomy), separating the platelet-rich plasma in a centrifuge, and injecting or microneedling it back into the skin or scalp. PRP is rich in growth factors that promote rejuvenation. Because it uses your own blood, allergic reaction is very unlikely. More than one treatment is usually required and results vary between individuals with no guarantee of outcome.

Common side effects include discomfort during and after the procedure, tightness, redness, swelling, a sunburned feeling, pinpoint bleeding, bruising, itching and scabbing. These usually settle within 24 hours to 7 days.

Uncommon side effects include skin infection (cellulitis), reactivation of cold sores, and temporary darkening or lightening of the skin, which usually fades within 6 months. Rarely, scarring may occur. There are also the risks of having blood taken: bruising, tenderness, feeling faint, and rarely haematoma, infection, vein inflammation or temporary nerve irritation.

A non-refundable deposit is required to secure your appointment. The balance is payable at your appointment. Deposits and booking fees are non-refundable unless agreed with the practitioner.

Medical screening

Please answer honestly — this keeps your treatment safe. Add detail in the notes where relevant.

1. Are you pregnant, breastfeeding, or trying to get pregnant?
2. Do you have any medical conditions? If yes, please give details.
3. Are you taking any medication (including blood thinners such as Warfarin/Aspirin)? If yes, please list.
4. Do you have any allergies, or have you ever had anaphylaxis? If yes, please give details.
5. Do you have any skin or neuromuscular disorders?
6. Do you have diabetes, an autoimmune disease, or a bleeding/clotting disorder?
7. Do you have a history of keloid or hypertrophic (raised) scarring?
8. Do you have any active infection, cold sores, or inflammation at the treatment area?
9. Have you had this or a similar treatment before? If so, did you have any problems?
10. What are your aims and motivations for the treatment / desired outcome? Please give details.
11. Is there any other medical or social history we should know? Please give full details.
12. Do you understand the information provided and feel it is sufficient for you to consent?
13. Has your consent been given freely?

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