• FACIAL PRP (PLATELET-RICH PLASMA) CONSENT FORM

  • 1. Purpose of Treatment

  • A PRP (Platelet-Rich Plasma) facial uses a small sample of my own blood, which is processed to separate the platelet-rich plasma. This plasma is then applied or injected into my skin to support skin rejuvenation.
  • 2. Description of the Procedure

    • A small amount of blood will be drawn from my arm.
    • The blood will be placed in a centrifuge to isolate the PRP.
    • The PRP will be applied to or injected into my face, depending on the technique used.
    • Multiple sessions may be recommended for best results.
  • 3. Potential Benefits

    • Improved skin texture and tone
    • Reduction in fine lines
    • Enhanced overall skin appearance
    • Natural treatment using my own plasma
  • 4. Risks and Possible Side Effects

  • I understand that, as with any cosmetic procedure, risks may include:
    • Redness, swelling, or bruising
    • Temporary discomfort
    • Infection
    • Allergic reaction (rare, as PRP is from my own blood)
    • No guarantee of results
  • 5. Contraindications

  • I confirm that I have informed the practitioner if I have:
    • Blood disorders
    • Active skin infections
    • Autoimmune conditions
    • Pregnancy or breastfeeding
    • Recent use of blood-thinning medication
    • Any other relevant medical conditions
  • 6. Alternatives

  • I understand that alternative treatments exist, including microneedling without PRP, chemical peels, laser treatments, or choosing no treatment.
  • 7. Voluntary Consent

  • I confirm that:
    • I have had the procedure explained to me.
    • I have had the opportunity to ask questions.
    • I understand the risks, benefits, and alternatives.
    • I am choosing to proceed voluntarily.
  • 8. Photography (Optional)

  • I consent/ do not consent (circle one) to before-and-after photographs for documentation or educational purposes.
  • Yes or No
  • 9. Acknowledgement

  • By signing below, I confirm that I have read and understood this consent form and agree to receive the PRP facial treatment.
  • Date of Birth:
     - -
    2 digit day, 2 digit month, 4 digit year
  • Format: 00000000000.
  • Date:
     - -
    2 digit day, 2 digit month, 4 digit year
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