*By submitting this form, you confirm that you are at least 21 years of age and consent for PHS HAIRSCIENCE®to collect, use, disclose and/or process your personal data submitted for marketing purposes and for you to receive marketing and promotional information by phone call, text messages and email. If you would like to withdraw your consent in future, please submit your request to[email protected]. Promotion for first-trial treatment is valid for a limited time only. PHS HAIRSCIENCE reserves the right to amend the promotional details without prior notice and without any liability.