I understand, that I have read and completed this questionnaire truthfully. I agree this constitutes full disclosure, and that it supersedes any previous verbal and written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or adverse reactions to treatments received. I am aware that it is my responsibility to inform my Aesthetician of my current medical and health conditions and to update this history. The treatments I receive here are voluntary and I release the Aestheticians of Lux Body Lab from liability and assume full responsibility

IF YOU ANSWERED YES TO ANY OF THE ABOVE, PLEASE LIST HERE THE PROCEDURE, CONDITION, MEDICATION, OR ALLERGY YOU MIGHT HAVE INCLUDING PROCEDURE DATES:Micro-needling is based on the skin's natural ability to repair itself. It creates superficial "micro- channels" to the outermost layer of the skin, inducing the healing process and 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.

Notify your technician PRIOR TO SIGNING THIS CONSENT if any of the following apply to you:

Cold sores, warts, open skin lesions, sunburn, extreme sensitivity, dermatitis, rosacea
Blood thinning medications
Accutane or generic brand within the past year
Pregnant or breastfeeding
Received chemotherapy or radiation therapy
Collagen Vascular Disease
Eczema, Psoriasis, or Dermatitis
Hemophilia/bleeding disorders
Keloid/hypertrophic scarring
History of autoimmune disease or any condition that may weaken your immune system