2 minutes to complete
The donor and the recipient must be above the age of 18 years. If the patient is below the age of 18 years, his or her parent or legal guardian must sign the consent form. The patient should be mentally and physically healthy. The patient must be in a stable financial condition as the surgery is expensive.The donor should be a close family member, preferably his or her child.
Patient Name
Age
Phone number
Address
Why do you want to have a hair transplant?
What are your expectations from the hair transplant surgery?
Are you aware of the risks and complications associated with hair transplant surgery?
Do you understand that the results of hair transplant surgery are not guaranteed?
Are you allergic to any medicines? if any please mention below.
Do you take drugs for any other problems? if any please mention below.
Are you willing to take the necessary steps to ensure the success of your hair transplant surgery?
I am aware of that hair transplantation is only a cosmetic procedure and have been involved in the decision of making about the choice of treatment. I have been explained the pros and cons of undergoing the procedure. I am aware that the procedure will be performed under local anesthesia and give consent for the same.
Signature
Date
BlockSurvey puts privacy and security above anything else. The use of end-to-end encryption is not a gimmick as in many products; it's a core feature enabling privacy and security. The survey building tools are impeccable. I've used numerous SaaS survey tools, and nothing comes close.
This platform goes far beyond basic surveys. I’ve used it for lead generation, landing page enrichment, and even embedded videos. Everything’s easy to use, well documented, and super flexible—whether you're building forms, quizzes, or something more advanced.
Uses end-to-end encryption technology that allows users to create survey forms where data is secure and private. UI looks very beautiful.
For our NGO, data privacy is everything—and this platform nails it. It keeps personal info fully protected while letting us design beautiful, chat-like surveys that increase engagement. Team collaboration features sealed the deal.
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BlockSurvey is very user-friendly with amazing customization options. It makes capturing data simple and secure. While the Web3 space still has room to mature, the platform itself is smooth and intuitive.
Creating surveys with BlockSurvey has been a breeze. The drag-and-drop interface is intuitive, and we’re able to collect data anonymously and securely—without intermediaries. It’s interactive, friendly, and encourages high participation while protecting user privacy. The reports are solid, and we’ve used it confidently for internal and external feedback.
Few tools combine data confidentiality and form aesthetics like this one. The conversational design improved my response rate by 43%, and the webhook integrations made syncing to our CRM effortless. I also love how responsive and community-driven the support team is.
I think BlockSurvey is good for short and long surveys. What I find the best is the fact that there are so many templates I can use and customize.
