1. Although, the majority of patients do not experience any complications with micro-needling, it is important you understand that risks do exist. The micro-needling procedure is minimally invasive, utilizing a set of micro-needles to inflict multiple, tiny, puncture/lacerations to the outermost layer of the skin. Because micro-needling penetrates the skin, it inherently carries health risks, including but not limited to those listed below. You should discuss any and all health concerns with your esthetician or attending healthcare provider PRIOR to signing this consent form.

2. I understand that micro-needling may cause infection, pigment/color change, scarring, pain, persistent redness, itching, and/or swelling, and/or an allergic reaction.

3. I understand that after the procedure, the skin will be red, with mild swelling and/or bruising, and might feel tight and sensitive to the touch. Although these symptoms may take 2-3 days to resolve completely, they will diminish significantly within a few hours after treatment.

4. I understand there are certain contraindications that would preclude me from receiving micro-needling treatments including active acne, active infection of any type (bacterial, viral, or fungal), cardiac disease/abnormalities, collagen vascular disease, eczema, psoriasis, or dermatitis, hemophilia/ bleeding disorders, keloid/hypertrophic scaring, pregnancy/lactation, raised lesions (moles, warts, etc.), skin cancer, sunburn, tattoos, telangiectasia/erythema, uncontrolled diabetes, vascular lesions (hemangiomas), rosacea, and scleroderma.

5. I understand that the use of Botox®, Juvederm®, Restylane®, and any other injectable must be disclosed prior to treatment.

6. I understand that there are some contraindicated medications: blood thinner medications,chemotherapy or radiation, hormone replacement therapy, recent use of some topical medication.

7. I understand that micro-needling is contraindicated within 72 hours of waxing, and within 1-3 weeks of a chemical peel.

8. I understand that while the goal of this treatment is to improve the vitality of the skin, no specific guarantees of the result can or have been made.

9. I understand that it is imperative to my health that I disclose all of the information requested in the Client Profile/Health History.

10. I have cited all conditions and circumstances regarding my health history, medications being taken, and any past reactions to products or medications.

11. I understand that I MUST avoid sun exposure for 1 to 2 weeks after a micro-needling treatment. I should also wear a daily SPF.

12. I consent to “before and after” photographs for the purpose of documentation, potential advertising, and promotional purposes.