Microneedling CONSENT FORM

Personalized Client Consultation
A proper skin consultation is important in any skin care treatment. Avoid clients with rosacea, sunburn and any raised lesions such as keloid scars, moles and active pustules. Review the personalized Plan of Treatment with the client for future visits. Review the personalized Home Care System with the client. Make sure the Client Waiver Form is filled out completely, dated and signed by the client prior to any service. Have the client remove contacts. Take client photos for documentation. * Please read and initial the following:

Frequency of Treatments: Due to the intensive exfoliation, without irritation to the skin, Micro-needling is recommended as follows:

* For All other skin types- 4-6 treatments at least 3-6 weeks apart. * For Acne skin types- Once every two weeks until the acne is under control. * Maintenance treatments- Every month to maintain the integrity of the skin.
Over microneedling can cause undue sensitivity to the skin's surface leaving the skin red and blotchy.
Post Care for Micro-Needling: Make up may be applied upon completion of the treatment.
Avoid exfoliants for 2-3 days after treatment due to sensitivity and redness. Always .use sunblock when outdoors.

My signature below acknowledges that I have read and understand the content of this informed consent document. I have been given ample opportunity to ask questions, all of which have been answered in a satisfactory manner. I understand that results can vary and that no guarantee, neither expressed nor implied, has been or will be given to me regarding my results. I'm aware of the risks and benefits associated with the Micro-needling procedure, as well as available alternative treatments. I understand that micro-needling is an elective procedure performed solely for cosmetic purposes and is not critical to my health. Of my own free will, I am requesting and providing my informed consent to undergo Micro-needling treatment(s) at Elmira Studio . I assume all risks as my own and agree to hold harmless, Elmira Studio , its providers, estheticians, and any other staff members, affiliates, and independent contractors. I hereby release them from any liability, both seen and unforeseen, now and forever.

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