CONSENT FORM FOR MICRONEEDLING
Ok, this is the consent form that I’m using in my studio. Correct it with your details
“THE NAME OF YOUR BUSINESS(write your business name)”
Microneedling treatment allows for controlled induction of the skin and self repair mechanism by Creating “micro-injuries” in the skin, which triggers collagen synthesis, yet does not pose the risk of permanent scarring. The result is smoother, firmer and younger looking skin.
Microneedling procedure are performed in a safe and precise manner with a use of sterile needle. The procedure is usually completed within 30-60 minutes, depending on the requirement and anatomical site.
Side Effects
After the procedure the skin will be red and flushed in appearance in a similar way to moderate sunburn. You may also experience skin tightness and mild sensitivity to touch on the area being treated. This will damage greatly after a few hours following treatment and within the next 24 hours the skin will be completely completely healed. After three days there is barely any evidence that the procedure has taken place.
Contraindications
Microneedling treatment is contraindicated for patients with: keloid scars, scleroderma, collagen vascular, diseases or cardiac abnormalities. A hemorrhagic disorder or hemostatic dysfunction, active bacterial or fungal infection.
Precautions and Warning
Microneedling treatment has not been evaluated in the following patient populations, as as such,precautions should be taken weather to treat: scars as stretch marks less than one year old; women who are pregnant or nursing, keloid scars; patients with history of eczema.
Psoriasis and other chronic conditions; patients with history of actinic (solar) keratosis; patients with history of herpes simplex infections; diabetics or patients with wound-healing deficiencies; patients on immunosuppressive therapy; and skin with presence of raised moles or warts or targeted area.
Patient Consent
I understand that results will vary among individuals. I understand that although I may see change after my first treatment, I may require a series of sessions to obtain my desired outcome.
The procedure and side effects have been explained to me including alternative methods, as have the advantages and disadvantages.
I am advised that though good results are expected, the possibilities and nature of complications cannot be accurately anticipated and that, therefore, there can be no guarantee as expressed or implied either as to the success or other result of the treatment. I am aware that microneedling treatment is not permanent as natural degradation will occur over time.
I stated that I have read (or it has read to me) and I understand this consent and I understand the information contained in it.
I have had the opportunity to ask questions about the treatment including risks or alternatives and acknowledge that all my questions about the procedure have been answered in a satisfactory manner.
This consent form is valid until all or part is revoked by me in writing.
Signature
Date: