Consent Form Home/Consent Form Microneedling Client Name: E-mail: I acknowledge that the practitioner has explained the nature of the microneedling treatment procedure, along with the possible risks and side effects, including infection, hyperpigmentation, hypopigmentation, redness, swelling (edema), bruising, skin sensitivity, dryness, or irritation. I understand that microneedling involves creating controlled micro-injuries in the skin to stimulate collagen production, and that the goal of this cosmetic procedure is aesthetic improvement and not perfection. I also understand that the number of treatments required may vary based on individual factors such as skin color, age, lifestyle, hormonal activity, skin conditions, and other influences that may affect treatment effectiveness. I acknowledge that results may vary and cannot be guaranteed. I hereby consent to the practitioner performing Microneedling treatments on me. In consideration of these treatments, I release and discharge the practitioner and the facility from all claims, demands, damages, actions, or causes of action arising from the performance of the treatment. This release applies to me, my heirs, executors, administrators, and assigns. I understand that there are no refunds on treatments. By signing below, I confirm that I have read and fully understand the information above, and I voluntarily consent to the treatment. Date: Practitioner Name: Witness Name: Signature: Yes, I Agree Δ