Microneedling Consultation and Consent Form

First Name

Last Name

Phone

Birthday

Address

Occupation

How often do you exercise?

Please list any skin or health conditions you are experiencing

To ensure the safety of all parties and to stop the further spread of the Covid-19 virus, please complete the below questions as honestly and accurately as possible prior to your appointment date.

Medical History

What is Microneedling?

Microneedling is a minimally invasive cosmetic procedure that’s used to treat skin concerns via collagen production. Also known as collagen induction therapy, this treatment may help those looking to reduce the appearance of acne scars and stretch marks.

It’s also used in certain anti-aging procedures, such as eyelid surgery and sun spots. Microneedling isn’t effective for hair loss, despite the possible role of collagen in hair growth.

Microneedling works by encouraging your skin to make more collagen. The idea is that pinpricks from the procedure cause slight injury to the skin and that the skin responds by making new collagen-rich tissue.

This new skin tissue is, in turn, more even in tone and texture. It’s normal for the skin to lose collagen via age or injury. By encouraging the skin to make new tissue, there may be more collagen to help make the skin firmer, too.

Procedure

During the procedure, your practitioner makes small pricks under the skin with a pen-like tool. The pinpricks are so small that you likely won’t notice them after the procedure. Your practitioner will move the tool evenly across your skin so that the new skin that rejuvenates will be even, too.

Before getting started, your practitioner will use a topical anesthetic to reduce the chances of pain. This is done about an hour before your treatment. The actual microneedling process takes approximately 30 minutes.

Your practitioner will then apply a serum or calming treatment.

Are there any risks or side effects?

Like all cosmetic procedures, microneedling isn’t without risk. The most common side effect is minor skin irritation immediately following the procedure. You may also see redness for a few days. Call your doctor if you notice more severe side effects, such as:

bleeding
bruising
infection
peeling

What to expect after Microneedling

Microneedling is a non-invasive treatment, so the recovery time is minimal. Most people require very little downtime if any at all.

You may notice skin irritation and redness within the first few days following the procedure. This is a natural response to the small pricks made by the needles in your skin.

You can go back to work or school after the procedure if you’re comfortable.

After microneedling, your skin works fairly quickly to rejuvenate new tissue. In theory, you should see results within a couple of weeks.

To maintain the results of your treatment, you’ll need multiple sessions and perhaps other complementing treatments. Your practitioner can advise you on the best plan of action based on your individual goals.

Appointment Guidance

If you have answered yes to any of the above questions we will be in contact as you may need to reschedule your appointment with us.
Please only attend at your appointment time.
Please ensure you are on time - if you are late this may result in your appointment being cancelled.
Please attend your appointment unaccompanied.
Please limit the personal possessions you bring with you.
Please wear a face mask/covering to your appointment.
Upon arrival please wait until you are called forward to reception.
Upon arrival please use the hand sanitiser provided.
Please maintain social distancing where possible.
If you experience Covid-19 symptoms after your appointment please contact us immediately.

I’m willing to get my body temperature checked before beginning my salon/clinic services. If my temperature is above 37 degrees celsius I agree to not visit the salon/clinic for the next 14 days.

I agree not to visit the salon/clinic for any of the services provided if I have the symptoms of Covid-19. I acknowledge that the information I have given in this consent form is accurate and complete.

I accept that any treatment I am going to receive is at my own risk.

I certify that I have read and fully understood and completed this form to the best of my knowledge.

I understand that failure to disclose information requested above may result in adverse side effect(s) and therefore I accept full liability/responsibility for the information given.

The treatment(s) and possible side effect(s) have been fully explained to me.

I accept full responsibility for the treatment given and complications which may arise or result during or following any procedure that is performed at my request.

I accept that if I am not satisfied with the treatment I will inform the therapist and/or request to speak to the manager during or immediately following the treatment.

I fully understand the above and consent to receive a Microneedling treatment.

Your Signature

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