Microneedling Consent Form

Prep your skin for the best, safest result:

Pause retinol, vitamin C, and exfoliating acids for 3–5 days before.
No Accutane/isotretinoin within the last 6 months.
Avoid sunburn and heavy sun exposure beforehand.
Reschedule if you have an active breakout, cold sore, or infection in the area.

For the first few days as your skin heals:

No makeup for 24 hours; use only a gentle cleanser and the products we recommend.
Wear SPF daily — your skin is more sun-sensitive now.
Avoid sweat, the gym, saunas, and swimming for 24–48 hours.
Hold off on retinol and acids for 3–5 days after.
Redness like a mild sunburn for 24–72 hours is normal; don’t pick at any flaking.

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Section A — Client Information

First Name *

Last Name *

Phone *

Email *

Date of Birth *

Today's Date *

City

State

Postal Code

Emergency Contact Name

Emergency Contact Phone

I agree to receive booking confirmations and appointment reminders at my email address above. *

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Section B — Photo Release

I consent to before/after photos being taken for use on social media and website.

Name preference for photos

Use my name No name Fictitious name

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Section C — Medical History

List any known allergies

List all current medications

Client preferences for next visit

Additional notes for next session

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Section E — Client Consent & Signature

Appointment reminders: I consent to receive appointment reminder messages via SMS. Reply STOP to opt out. Promotions: I consent to receive promotional and marketing messages from I Am Beautiful by Mia. Reply STOP to opt out.

By checking the SMS boxes above, you agree that I Am Beautiful by Mia may contact you at the number provided. This is not a condition of service.

Before Your Appointment

Aftercare

Section A — Client Information

Section B — Photo Release

Section C — Medical History

Section D — Microneedling Contraindications

Section E — Client Consent & Signature