Collagen Induction Therapy Consent Form
I authorize Strawberry Skin LLC to perform Micro-Needling treatments for me. I understand that Micro-needling is a treatment wherein a fine needle will be introduced through the skin. This will combine active ingredients to go deeply into the dermis. Normally, 3-5 treatments are required to see the result. I understand that I might experience the following side effects and will confirm that it is normal. I also understand that it will go back to normal within 24-48 hours. • Flushed or red skin • The tightness of the skin • Mild sensitivity to touch • Moderate sunburn • Itching and burning I confirm that I will follow the pre-care and post-care instructions by the specialist. I understand that this procedure does not guarantee any specific result. I understand the risks and complications of this procedure and I still like to proceed with it. These are the following risks: infection, hyperpigmentation, allergic reaction, scarring, pain, itchiness, or swelling. I understand that this procedure or service is non-refundable. I release Strawberry Skin LLC from any liabilities and hold harmless against damages or accidents that might happen during the procedure. I confirm that I had the chance to ask any questions about the treatment to the specialist and I receive satisfactory replies. I confirm that I will consult my physician if I have the following contraindications: Rashes Acne Skin infection Viral, fungal, bacterial infection, Pregnant, Diabetes Taking NSAIDS, Warfarin, or any anticoagulants
I consent to the above
I do not consent to the above and will not be receiving this treatment.
Signature
Submit
Should be Empty: