Consent Forms
Review each treatment consent form here. Logged-in clients can update their saved answers; guests can print any form and log in to submit it online.
Microneedling Consent Form
Patient Information
Procedure Overview
Microneedling, or collagen induction therapy, is a cosmetic procedure that involves the use of a device equipped with fine needles. These needles create small punctures in the top layer of the skin, which is designed to trigger the body's wound healing processes to enhance collagen and elastin production. This treatment is aimed at improving skin texture and appearance, addressing concerns such as fine lines, wrinkles, scars, and pore size.
Indications for Microneedling
- Enhances skin texture and elasticity.
- Reduces the appearance of scars, including acne and surgical scars.
- Minimizes wrinkles and fine lines.
- Decreases pore size and improves skin's overall appearance.
- Facilitates deeper absorption of topical skincare products.
Contraindications
Please inform us if you have any of the following, as they may affect your suitability for microneedling:
Potential Risks and Discomforts
You may experience:
- Temporary redness, swelling, and bruising at the treatment site.
- Minor bleeding or prickling sensation during the procedure.
- Post-treatment itching or increased sensitivity.
- Infrequently, there is a potential for infection, pigment changes, or scarring.
Informed Consent
Understanding the Procedure: I acknowledge that I have been fully informed of the nature of microneedling, the procedure details, and the mechanism by which it is expected to improve skin appearance. I understand that while many patients benefit from microneedling, results may vary and cannot be guaranteed.
Acknowledgment of Risks: I recognize that, as with any cosmetic treatment, there are certain risks and unknown possibilities. I accept these risks and agree to undergo treatment after having had the opportunity to discuss any concerns I might have with my practitioner.
Voluntary Participation: I am participating freely and without coercion. My questions, if any, have been answered, and I have been offered the opportunity to ask questions until they have been answered to my satisfaction.
Photography and Data Use Consent
I authorize the use of clinical photographs of my treatment areas for the purpose of medical record documentation, educational purposes, and promotional materials for professional audiences. My privacy will be respected in the use of any photographs.
Aftercare Instructions
I agree to follow all aftercare instructions provided by the clinic to ensure the best possible healing and treatment results. This includes avoiding excessive sun exposure, applying recommended skin care products, and attending follow-up sessions as scheduled.
Financial Agreement
Release from Liability
I release the practitioner and the clinic from liability for any complications that may arise from the microneedling procedure, provided that it is performed according to standard practice and aftercare instructions are followed.