Facial Forms | Lash & Ink Boutique

Microneedling & Nano Infusion Consent

First Name

Last Name

I give my consent and understand that Microneedling and Nano Infusion results will vary among individuals. I understand that although I may see a result after my first session, I may require a series of sessions to obtain my desired results. I understand that results are semi-permanant and not guaranteed although good results are expected.

I give my consent and understand the precautions, warnings and contraindications of Microneedling and Nano Infusion such as: Keliod scars, scleroderma, collagen vascular diseases, cadiac abnormalities, a hemorrhagic disorder or haemostatic dysfunction, active bacterial or fungal infection. Precautions should be taken by people with less than one year old scars or stetch marks, women who are pregnant or nursing, history of eczema, psoriasis, herpes simplex infections, diabetes or clientss with wound healing deficienies; including clients on immunosuppresive therapies.

I give my consent and understand that after the treatment my skin may be red or flushed. Skin may also feel tight and be mildly sensitive to touch in certain areas. This will diminish significantly with in a few hours following the treatement. Within the next 12 hours I may need to stay out of direct sunlight, or tanning beds, as the skin will be more sensitive. After 3 days the skin shoud be completely healed.

By signing this form I acknowledge that all my questions and concerns have been answered about Microneedling or Nano Infusion. This form is valid until all or part is revoked by Meredith Brooke Salon and any of its affiliates in writing.

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I declare that the info I’ve provided is accurate & complete

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Lash & Ink Boutique

Microneedling & Nano Infusion Consent

MICRONEEDLING

Please email any photos of your facial skin in the areas you want treatment .

Please also email photos of any facial products you're currently using, with the ingredient label.

Please email your photos to:
info@meredithbrookesalon.com

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Microneedling & Nano Infusion Consent

MICRONEEDLING

Please email any photos of your facial skin in the areas you want treatment . Please also email photos of any facial products you're currently using, with the ingredient label. Please email your photos to: info@meredithbrookesalon.com

Please email any photos of your facial skin in the areas you want treatment .

Please also email photos of any facial products you're currently using, with the ingredient label.

Please email your photos to:
info@meredithbrookesalon.com