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  • SKIN TREATMENT: Informed Consent Form

    Allana Davis Studio
  • Personal Information

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  • Medical Information:

  • Female Specific Information

  • Tanning or Sun Exposure

  • Milia Remival Consent: By proceeding with our Milia removal treatment, you acknowledge and accept the risks associated with this procedure. This treatment involves the use of a sterile lancet needle to gently extract Milia, which are small, keratin-filled cysts typically found on the skin. While we adhere to the highest standards of care and hygiene, as with any skin treatment, there is a risk of side effects, including but not limited to scarring, pigmentation changes, or infection. By signing this form, you agree not to hold [Your Business Name] or its practitioners liable for any such outcomes. We are committed to providing you with a safe and effective treatment and will discuss any concerns you may have prior to the procedure.

  • By signing below, I acknowledge and consent to the following statements:

    I acknowledge that temporary skin irritation, breakout, tightness, redness, or slight swelling may occur after the treatment, which usually dissipates within 72 hours depending on my skin sensitivity.

    I acknowledge that if I have any allergies to the products used, I may experience allergic reactions.

    I acknowledge that failure to use a minimal SPF 30 sunscreen may result in sunburn, skin damage, and hyperpigmentation, and I should avoid excessive sun exposure, especially between 10am-2pm.

    I acknowledge that this treatment is strictly an elective cosmetic procedure, and no medical claims have been expressed or implied.

    I acknowledge that I should avoid using Retin-A type products, aggressive exfoliation, waxing, and products containing acids that are not part of the recommended take-home regimen for 2-4 weeks following the treatment unless discussed with my aesthetician at Allana Davis Studio (operated by MakeupLady Canada).

    I acknowledge that I have informed my esthetician of any medical conditions, allergies, or medications that could increase the risk of complications during or after the treatment.

    I acknowledge that I have been provided with a detailed description of the facial/microneedling procedure that will be performed, including the equipment and products that will be used, the length of the treatment, and any post-treatment instructions.

    I acknowledge that there are risks associated with this facial/microneedling treatment, and I assume all responsibility for any complications that may arise. I release Allana Davis Studio (operated by MakeupLady Canada) and its staff from any liability, claims, damages, or expenses that may result from the treatment.

    I give consent to the best of my knowledge that the answers I have provided are correct and that I have not withheld any relevant information for my treatment. I also give consent for all future treatments.

    I acknowledge that [your business name] carries insurance coverage for this facial/microneedling treatment and that this consent form meets the insurance provider's requirements.


    Cancellation Policy:

    At the Allana Davis Studio (operated by MakeupLady Canada), we highly value your appointments and consider them a top priority. We reserve your appointment slot exclusively for you and understand that schedule changes may become necessary. We kindly ask that you provide us with a minimum of 24 hours' notice for any cancellations.

    For appointments cancelled less than 24 hours in advance, a charge equivalent to 100% of the original appointment cost will be applied to your credit card on file or billed at your next appointment. For same-day cancellations, the full cost of the original appointment will be charged to your credit card on file or billed at your next appointment. We appreciate your understanding and cooperation.

  • I have read and understood the information provided in this consent form, and I agree to the terms and conditions. 

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