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Micro Needling Consent Form

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MicroNeedling is an elective procedure for cosmetic purposes only. I have had the opportunity to ask questions and understand the nature, goals, limitations and possible complications of this treatment. I have had the opportunity to discuss alternative forms of treatment and understand that results may vary.

I Clearly understand and accept the following:


  • The goal of these treatments, as in any cosmetic procedure, is improvement - not perfection. I understand my results might not be perfect, and the number of treatments necessary may vary.

  • There may be more treatments necessary than I anticipated.

  • There is no guarantee that expected or anticipated results will be achieved.

  • I understand that compliance with recommended aftercare guidelines are crucial for healing and prevention of scarring or skin textural changes.

  • Discomfort at the treatment site with transient redness and swelling which may last up to two hours or longer. The redness may last up to 2-3 days. The treated area may feel like a sunburn for a few hours after treatment.

  • Increased or decreased pigmentation is possible and can take 3 to 6 months or more to resolve.

  • Loss of pigmented lesions such as freckles may give the appearance of loss of pigment.

  • Small areas of scabbing may occur 2-3 days following the treatment.

  • Infection is possible if proper aftercare guidelines are not followed


I understand there are certain contraindications that would preclude me from receiving micro-needling treatments including pregnancy, 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.


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


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.


I hereby release Bossy Glam Studio Inc as well as my treatment provider from any liability associated with my Micro Needling treatment. I grant Bossy Glam Studio Inc & it's employees the right to use any photographs, testimonials, or other information that I knowingly provide for promotional purposes.

If you are a new client, you must complete and fill out the consultation/medical history form - available in the forms section or from your treatment provider.
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