REMOTE CONSULT FORM — Donovan Hair Clinic

INTERNATIONAL CONSULT FORM

Thank you for your interest in a consultation. Dr. Donovan looks forward to speaking to your about your hair loss. We appreciate the effort you have put in to forwarding your test results and completing the intake questionnaire. 

For all patients residing outside of Canada, our clinic does require the following Consult Agreement Form to be completed as well. It is a standard form that medical facilities in Canada often use for International patients receiving consultations from Canadian specialists. Every aspect of your care will be identical to Canadian patients. In a similar realm, any legal action that would be brought about to Dr. Donovan, or our clinic will be conducted in Canada and under Canadian law according to the details of the following agreement. Please complete this form and return to our office by email, fax or regular mail. If the patient is under 18 years of age, we would ask that a parent or guardian complete the form.

INTERNATIONAL CONSULT FORM

 



 

 




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