online skincare consent waiver

What is needling?

Micro-needling or Nano-needling devices intentionally create very superficial “micro-injuries” to the outermost layer of the skin, inducing the healing process including new collagen production. Micro-needling has been shown to reduce the visibility of acne scars, fine lines, and wrinkles, diminish hyperpigmentation, and improve skin tone and texture, resulting in smoother, firmer, younger-looking skin. Skin needling treatments are performed in a safe and precise manner with the sterile devices and are normally completed within 30-60 minutes, depending on the selected area.

What should you expect?

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.

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I understand that micro-needling may cause infection, pigment/color change, scarring, pain, persistent redness, itching, and/or swelling, and/or an allergic reaction. * Please click the yellow area and provide your initials here.

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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. * Please click the yellow area and provide your initials here.

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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. * Please click the yellow area and provide your initials here.

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I understand that the use of Botox®, Juvederm®, Restylane®, and any other injectable must be disclosed prior to treatment. * Please click the yellow area and provide your initials here.

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I understand that there are some contraindicated medications: blood thinner medications, chemotherapy or radiation, hormone replacement therapy, recent use of some topical medication. * Please click the yellow area and provide your initials here.

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I understand that micro-needling is contraindicated within 72 hours of waxing, and within 1-3 weeks of a chemical peel. * Please click the yellow area and provide your initials here.

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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. * Please click the yellow area and provide your initials here.

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I understand that it is imperative to my health that I disclose all of the information requested in the Client Profile/Health History. * Please click the yellow area and provide your initials here.

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I have cited all conditions and circumstances regarding my health history, medications being taken, and any past reactions to products or medications. * Please click the yellow area and provide your initials here.

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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. * Please click the yellow area and provide your initials here.

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I consent to “before and after” photographs for the purpose of documentation, potential advertising, and promotional purposes. * Please click the yellow area and provide your initials here.

I understand that if I have any concerns, I will address these with my esthetician. I give permission to Panda Pampering to perform the micro-needling or nano-needling procedure we have discussed, and will hold Panda Pampering harmless and nameless from any liability that may result from this treatment.

I have accurately answered the questions above, including all known allergies, prescription drugs, conditions, or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my treatment, I will consult Panda Pampering immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold Panda Pampering, responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.

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Online skincare consent waivers simplify the signing process.