• Weave Dr's Trichology/ Nutrition Consent/ Release Form

    Please fill out the application form carefully

  • Personal Information

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  • Questionnaire For Hair Loss/ Nutrition

  • Do you deal with fatigue?
  • Do your deal with excessive worry, anxiety, depression?
  • Are you currently dealing with any inflammation in the body currently?
  • Do you deal with any cognitive or neurological disorder?
  • Do you deal with anger and irritability?
  • Do you deal with anxiety ?
  • Do you have muscle cramps and joint pain?
  • Do you eat a diet high in carbs or sugar
  • Are you currently using chemicals on your hair?
  • Do you deal with constipation or diarrhea or digestion problems?
  • Do you drink alcohol excessively?
  • Are you a heavy or light sweater?
  • Do you have stretch marks, spider veins and white marks on the nails?
  • Do you have circulation problems?
  • Are you looking for a monthly flexible program?
  • Do you desire to learn about metal toxicity and your bodies mineral analysis?
  • Do you live life on the edge?
  • Are you interested in participating in natural detox therapy?
  • Do you deal with problems with the female/ male reproductive system?
  • Do you use aluminum pots/ pans for cooking?
  • Are you interested in starting a new and serious lifestyle/ nutrition change?
  • Do you eat fast food more than 3x a week consistently?
  • Are you over or underweight?
  • Do you smoke or vape?
  • Do you take creatine?
  • Do you have less fat in thigh and buttocks area?
  • Do you have low energy in the morning?
  • Do you notice hair loss when under stress ?
  • Do you deal with regular fatigue, struggle through the day?
  • Do you deal with asthma ?
  • Do you deal with low blood pressure or dizziness upon standing?
  • Do you deal with low blood sugar?
  • Do you deal with excess weight in or have a curvy build?
  • Do you deal with excess weight in or have a curvy build?
  • Do you deal with low to slim weight , have issues gainning weight?
  • Do you receive a full 8-10 hrs of uninterupted sleep per night.
  • Are you sensitive to cold, experience tingling in hands feet or extremeties?
  • Are you wired at night and tend to fight sleep?
  • Are you awaken around 2-3 am and have racy thoughts before o during bed time?
  • Do you stay on social media or electronics more than 3 hrs a day?
  • Do you deal with food cravings?
  • Do you have epilepsy?
  • Do you have metal in the body , pace maker , steel plates, metal in mouth?
  • What is your current level of income per year?
  • I understand that some of the benefits from our products are as followed. *Easy To Use Hair Growth System •Education on The Science of Regrowing Your Hair with Educational Videos. •Coaching on the The Effects of Low Grade Inflammation on the body •Proven Hair Regrowth System on All Hair Condition’s & Scalp Disorders. •Customer support. •Organic Non Toxic Ingredients. •Free consultation for your Alopecia Journey. •Payment Plans.

  • Weave Dr @ Pure Virgin Mane/Mane Attractions

    I am aware that : 1. PVM and Mane Attractions cannot be held responsible for any pre-existing medical conditions are allergic reactions. 2. I must consult any changes in diet or topical serums with my doctor to reduce the chances of medication side effects and unknown health risk. 3. I must fully comply with proven programs and remain consistent for best results. 4. Our Hair company can help regrow back some hair and all results will vary depending on the hair condition/ medical and physiological issues and commitment given from each client. 5. Mane Attractions/ PVM does not claim to diagnose,treat, cure or prevent any diseases. We are certified holistic health practitioners and trichology hair practitioners. 6. All sales and services ARE FINAL and I agree to have my credit card authorized when using credit/ debit cards on agreed upon services. Any credit card fraud will be subject to arbitration and the laws in Maryland.I understand that Mane Attractions preferred form of payment if through zelle, cash app and venmo. All card users will have to complete a credit card authorizatiom form. All credit cards will be stored on file for charge backs, disputes and debts agreed upon for services and hair units/ extensions. These cards will only be used for these purposes. I agree to these terms and conditions.I understand that if I change my mind because of buyers remorse , description changes or delays that i will still be required to pay in full. 7. You can cancel services at any time however you may not experience the complete results. Most programs last 6 months - 1-2 yrs for best results. I release and hold harmless any false claims disputes and court cases against Mane Attractions/ PVM. 8. PVM and Mane Attractions cannot be liable for buyers remorse. 9. All Trichology/ Nutrition services are due before appointment. Policies: 1. All clients who do frequent cancellations will have to pay full deposit for future appointment. 2. No Children allowed to appointments. 3. Any client that demean and who becomes overly confrontational may be referred to another hair loss provider. 3. Hair Wigs lifespan will vary from individual clients lifestyle and maintenance level. 4. Please refrain from chemicals usage to maximize your hair growth cycle. 5. Please be patient when ordering units and customized hair pieces. NO Rush Orders, order in advance for best results and schedule complete wig consultation appointment. 6. All units require an 80% deposit. 7. Please talk to your primary physician before removing medications, changing you diet or taking new supplements. 8. Use caution and notify physician when doing sauna therapy to monitor blood pressure levels and staying properly hydrated. 9. Hair biopsies can take up to 3 weeks for results and they must be performed every 3-4 months. WE ARE NOT MEDICAL DOCTORS, AND ARE CERTIFIED NON LICENSED MEDICAL HEALTH PRACTITIONERS THAT USE NUTRITION HOLISTIC REMEDIES AND NON SURGICAL HAIR REPLACEMENT AND DETOX PROTOCOLS TO ASSIST OUR PATIENTS. 10. Healing reactions are normal and can be uncomfortable when starting a detox program. If you are in am emergency call 911. We cannot be held liable for improper or regular usage of our suggested detox methods, diet protocols or vitamin recommendations. Verify all things with your physician for your best results and safety.

  • Weave Dr Hair Loss and Wellness Clinic

    12138 Central Ave #221 Bowie, Md 20721

    chelsea.y.mitchell@gmail.com

    703.973.7146

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