Are you planning to provide microneedling services at your spa or clinic?
Before you begin, it is important to protect both you and your client with a professional consent form.
In this post, we will be sharing two microneedling consent forms templates: one black and white, and one colored.
These two forms are designed in Google Docs and are 100% free and customizable.
Usage Note: These templates are free to use for both personal and commercial purposes. However, redistribution, resale, or uploading these templates to other websites or platforms for download or sale is strictly prohibited. Please respect the effort that went into creating these resources by using them responsibly.
How to Use These Templates
To use these templates, follow these easy steps:
- Make sure you are logged in to your Google Account.
- Click on the “Get this template” button below the preview image.
- Click on the “USE TEMPLATE” button.
- Customize the form, if needed.
- Print.
Microneedling Consent Form Template (B&W)
This consent form is designed to help skincare professionals to clearly communicate the microneedling procedure and secure informed consent.
We’ve used tables to organize each section so that it looks professional and is easy to read.
This Template Includes:
| Section | Fields Included |
|---|---|
| Client Information | Full Name, Date of Birth, Phone Number, Email Address, Address |
| Procedure Description | Overview of microneedling, collagen stimulation, and common benefits |
| Health Screening Questions | Yes/No checklist covering: pregnancy, active infections, medications, allergies, skin conditions, cosmetic history |
| Pre-Treatment Acknowledgment | Guidelines on sun exposure, exfoliation, product usage, and full disclosure of medical history |
| Risks and Side Effects | Table of potential side effects like redness, swelling, bruising, infection with client initials |
| Post-Treatment Care Instructions | Aftercare steps including SPF use, avoidance of makeup, workouts, pools, and use of gentle products |
| Results and Expectations | Statement clarifying that multiple sessions may be needed and results can vary |
| Consent and Release | Legal acknowledgment of understanding, acceptance of risks, and release of liability |
| Signature Fields | Client Signature, Date, Provider Signature, Date |
Microneedling Consent Form Template (Color)
