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Consent Form

Please complete this consent form before your Microneedling appointment. Once you sign, a copy is emailed to you and to Gemma automatically.

Your details

Microneedling — treatment information & disclaimer

Microneedling uses a device to create multiple tiny micro-punctures in the skin, triggering the skin's natural repair process and new collagen production to improve texture, fine lines, pores, scarring and pigmentation. Topical anaesthetic cream is usually applied first. More than one treatment is generally required and results vary between individuals with no guarantee of outcome.

Common side effects include discomfort/stinging, a tight, swollen, sunburned feeling, redness, pinpoint bleeding, bruising, itching, scabbing and temporary darkening of the treated area. Redness and sensitivity usually settle within 24 hours to 7 days.

Uncommon side effects include skin infection, reactivation of cold sores, and hyper- or hypo-pigmentation (usually fading within 6 months, rarely permanent). Rarely, scarring may occur. Avoid excessive sun exposure before and after treatment and use SPF as advised.

A non-refundable deposit is required to secure your appointment. The balance is payable at your appointment. Deposits and booking fees are non-refundable unless agreed with the practitioner.

Medical screening

Please answer honestly — this keeps your treatment safe. Add detail in the notes where relevant.

1. Are you pregnant, breastfeeding, or trying to get pregnant?
2. Do you have any medical conditions? If yes, please give details.
3. Are you taking any medication (including blood thinners such as Warfarin/Aspirin)? If yes, please list.
4. Do you have any allergies, or have you ever had anaphylaxis? If yes, please give details.
5. Do you have any skin or neuromuscular disorders?
6. Do you have diabetes, an autoimmune disease, or a bleeding/clotting disorder?
7. Do you have a history of keloid or hypertrophic (raised) scarring?
8. Do you have any active infection, cold sores, or inflammation at the treatment area?
9. Have you had this or a similar treatment before? If so, did you have any problems?
10. What are your aims and motivations for the treatment / desired outcome? Please give details.
11. Is there any other medical or social history we should know? Please give full details.
12. Do you understand the information provided and feel it is sufficient for you to consent?
13. Has your consent been given freely?

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