I hereby give my consent to undergo Collagen Induction Therapy (Micro-Needling) treatments provided by my licensed professional, Mari van Schalkwyk.
 
I understand this technique involves the introduction of fine needles through the skin.  The purpose is to create micro-channels in the skin allowing the infusion of active ingredients (such as vitamin c, hyaluronic acid Collagen Induction Enhancement serum) to penetrate deeply and effectively into the dermis, nourishing the skin and stimulating the regrowth of collagen. A series of treatments of 4-6 are recommended and the frequency will depend on the intensity and depth of the needle. I understand that the treatments require may small injections and the are(s) to be treated. I understand that the administration of numbing creams may be used if needed.
 
I understand that I cannot undergo Micro-Needling under the following circumstances:
-Accutane (isotretinoin) use within the last year
-Open wounds, cuts or abrasions on the skin
-Current skin infection, condition, herpes simplex in the area to be treated
-Radiation treatments to the skin within the last year
-Pregnant or breastfeeding
-History of keloid scars or hypertrophic scars
 
I understand that there are some risks with any procedure. The following are possible reactions with Micro-Needling: Temporary bruising, skin discomfort during injections, redness or swelling, lightning or darkening of the skin, itching, and burning. 
Skin infection is a possibility any time an injection or surgical procedure is done.  Side effects are most of the time temporary and typically resolve within 3 days. Total healing time depends on the depth of the treatment, skin type, and skin condition, and some patients may heal completely in 24 hours. 
 
By my signature, I certify that I have thoroughly read and understand the contents of this form and the disclosures listed above were made to me. I acknowledge the no promises or guarantees have been made to me as a result of the treatment.
I am aware that the results achieved by this treatment may vary from person to person.  Some patients typically notice an immediate glow, but visible improvement will take about 2-4 weeks and can continue for up to 6 months.
 
I have read potential risks have been explained to me and I accept them.
I herby give my voluntarily consent to have this treatment performed on me.