BB Glow Consultation and Waiver Form

  • BB Glow Consultation & Consent Form

  • Personal/Medical History Form

    To provide you with the BB Glow treatment, please complete the following questionnaire. All information you provide will remain strictly confidential and is used to ensure your safety and the best possible results.

  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • How did you hear about us?*
  • Are you currently under the care of a physician for management of an illness or condition?*
  • Do you have any Botox or other injectables on the last 30 days?*
  • Have you ever had an allergic reaction to any food, drug or enviromental source?*
  • Are you pregnant or trying to become pregnant?*
  • Are you breastfeeding?*
  • Are you currently using any topical skincare products (prescription or over-the-counter)?*
  • Do you have any heart conditions or a pacemaker?*
  • Do you have high blood pressure?*
  • Do you have diabetes (Type I or II)?*
  • Are you on any blood-thinning medications or immunosuppressive drugs, such as aspirin?*
  • Have you used Accutane, isotretinoin, or been treated for acne in the 6 months?*
  • Do you use skincare products with Retin-A, Retinols or Vitamin A?*
  • Do you have any known allergies to serums or ingredients used in BB Glow treatments?*
  • Have you had a chemical peel or exfoliation treatment in the last 30 days?*
  • Do you have any known allergies to lidocaine, or numbing agents?*
  • Are you taking any antibiotics or photosensitizing medications?*
  • Do you have any active rashes or sunburns?*
  • Have you had any facial procedures done in the last 30 days?*
  • Are you currently using any products containing tretinoin, glycolic acid, salicylic acid, or other active ingredients?*
  • Do you have a history of, or currently experience, epilepsy or seizures?*
  • Rows
  • Do you have any other health problems or medical conditions not listed above?*
  • Have you had any recent medical procedures?*
  • Do you have any chronic medical conditions?*
  • Do you currently have any blemishes, cuts, irritation, or infections on the area to be treated?*
  • Do you have any moles, raised areas, prior or current in the projected procedural area?*
  • In the last 4 weeks have you had any dermal treatments such as tattoos, dermal fillers, piercings or botulinum toxin?*

  • Treatment Information

  • What is BB Glow?

    BB Glow is a semi-permanent skin treatment that combines microneedling with the infusion of tinted serum. This innovative procedure uses a microneedling device to deliver pigment-enriched serums into the upper layers of the skin. Although the term “microneedling” may sound intimidating, the procedure is typically well-tolerated and minimally invasive, with little to no discomfort.

    The primary benefits of BB Glow include:

    • Immediate skin-brightening effects
    • A more even complexion
    • Reduction in the appearance of pigmentation, redness, or acne scars
    • Boosted collagen production due to the microneedling component, which may enhance skin texture and firmness over time


    The tinted serums used in BB Glow are formulated with active nutrients and anti-aging ingredients. After the procedure, improvements continue for up to two weeks, and long-term skin rejuvenation effects may develop over several sessions.


    Procedure Overview

    A typical BB Glow session takes approximately 1.5 to 2 hours, depending on your skin type and condition. Prior to the treatment, a consultation is performed to evaluate your skin, choose the most appropriate serum shade, and ensure suitability for the procedure. Customized pigment blends may be used to best match your natural skin tone.


    Benefits of BB Glow

    • Flawless, makeup-like appearance without actual foundation
    • Improved skin texture, hydration, and radiance
    • Diminished appearance of fine lines, hyperpigmentation, and enlarged pores
    • Confidence boost from smoother, more even-toned skin
    • Anti-aging benefits from collagen stimulation
    • Enhanced nutrient absorption due to deeper serum penetration



    Important Considerations

    • BB Glow is a cosmetic treatment and not a replacement for medical skincare or dermatological procedures.
    • Results vary depending on individual skin conditions and post-treatment care.
    • Multiple sessions may be recommended to achieve and maintain optimal results.
    • This treatment involves the use of pigments and active ingredients that are not FDA-approved for injection and are considered cosmetic.
    • Clients with certain medical or skin conditions may not be suitable candidates.

  • AFTERCARE

  • BB GLOW AFTERCARE INSTRUCTIONS
    To ensure optimal results and minimize the risk of complications, please follow these aftercare guidelines carefully:

    • Do not wash your face or get the treated area wet for at least 24 hours after the procedure.
    • Avoid makeup on the treated area for 48 hours post-treatment.
    • Do not touch, rub, or scratch the treated area to prevent irritation or infection.
    • Avoid active skincare ingredients such as retinol, tretinoin, AHA/BHA acids, vitamin C, or exfoliants for 5 days after the treatment.
    • Avoid sun exposure, tanning beds, saunas, hot tubs, and excessive heat for at least 72 hours.
    • Refrain from swimming or heavy sweating (e.g., intense workouts) for 3 days post-treatment.
    • Use a gentle, hydrating cleanser and apply a soothing serum or moisturizer daily to help nourish and calm the skin.
    • Apply SPF 30 or higher every day, even indoors or on cloudy days, to protect the treated skin.
    • Do not exfoliate or use scrubs on the treated area until the skin has fully healed.
    • If any unusual discomfort, redness, or signs of infection occur, contact your technician or a healthcare professional.

  • ACKNOWLEDGMENT

  • Please read each statement carefully. By checking each box, you confirm that you understand and agree to the statement.

  • I,         I confirm that I am over the age of 18, am not under the influence of drugs or alcohol, and am not pregnant or nursing. I voluntarily consent to receive the BB Glow treatment. I understand the nature of the procedure, as well as the associated risks and possible complications. I acknowledge that I am choosing to proceed of my own free will, without any pressure or coercion.

  • Date*
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