Jardin Secret Spa/Wellness Center

Client Form 5 – Microneedling Treatment Consent Form

Client Information

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Description of Service
Microneedling treatment allows for controlled induction of the skin's self-repair mechanism by creating “micro”-injuries in the skin, which triggers collagen synthesis, yet does not pose the risk of permanent scarring. The result is less textured, smoother, more firm, youthful-looking skin!
I have read and understand the description of this service.
Clear Signature
Possible Side Effects

After the procedure, the skin will be red and flushed in appearance similar to a moderate sunburn. You may also experience some skin tightness and mild sensitivity to the treated area. This will diminish greatly in the next 24-48 hours post-procedure. After 3 days, most, if not all, redness will be gone. After 7-10 days you will be healed. You should apply sunscreen DAILY to your skin. Do not be in direct sunlight for 24 hours post-procedure. Discontinue any retinol for the next week as well.

Some possible side effects include: skin redness, flaking/itching, short-term swelling, fever blisters, bruising, and infection.

I have read and understand the possible side effects of this service.
Clear Signature
Patient Consent
  • I understand that results may vary upon individuals.
  • I understand that I may need multiple treatments to achieve desired results. I understand that at-home skin care maintenance is required to achieve optimal results.
  • I am NOT pregnant or lactating.
  • If outdoors, I will apply SPF of 35 or higher 30 minutes prior to sun exposure.
  • In rare cases, allergies or sensitivities have been reported to products used during the procedure.
  • The procedure and side effects have been explained to me. I am advised that though good results are expected, the possibility and nature of complications cannot be accurately anticipated and that there can be no guarantees expressed or implied either as to the success or other results of the treatment./li>
  • I am aware that microneedling treatment is not permanent as natural degradation will occur over time.
I have read the above statements and consent to this treatment.
Clear Signature
I understand that I will undergo microneedling treatment and fully consent to have this procedure performed.
I release Jardin Secret, staff, and specific technicians from liability associated with this procedure.