• JULIET MICRONEEDLING CONSENT FORM

  • 1. Treatment Overview

  • Juliet Microneedling is a cosmetic procedure that creates controlled micro-injuries in the skin to improve texture, tone, and overall appearance. Topical products may be applied during or after treatment as determined by the provider.
  • 2. Risks & Side Effects

  • I understand that possible side effects may include:
    • Redness, swelling, or sensitivity (24–72 hours)
    • Mild discomfort or pinpoint bleeding
    • Dryness or peeling
    • Bruising or temporary discoloration
    • Risk of infection if aftercare is not followed
    • Possible herpes simplex (cold sore) activation
    • Rare allergic reaction
    Results may vary depending on individual skin condition.
  • 3. Contraindications

  • I confirm that I do not have:
    • Active skin infection or open wounds
    • Active herpes outbreak
    • History of poor wound healing or keloids
    • Recent isotretinoin (Accutane) use (within 6 months)
    • Any condition that may impair healing
    • Use of medications that can lead to hyperpigmentation: hydroxychloroquine (Plaquenil)
    • Pregnancy
    • Active Acne
    • Eczema on the areas to be treated
  • 4. Aftercare Agreement

  • I agree to:
    • Follow post-treatment instructions
    • Avoid makeup for 24 hours
    • Avoid sun exposure, heat, and harsh skincare products for 1 week
    • Use sunscreen regularly
    • No chemical peels
    • No tanning
    • No excessive workout or sweating for 24 hours
  • 5. Consent

  • I have read and understood this information.
    I have had the opportunity to ask questions and agree to proceed with the treatment.
  • Date:
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  • Should be Empty: