eDermastamp™ Microneedling Informed Consent Form

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The eDermastamp™ microneedling device is designed to stimulate the skin’s natural ability to repair itself. By creating controlled “micro-injuries” in the outer layer of the skin, the treatment triggers the healing process and encourages new collagen and elastin production. Microneedling can help improve the appearance of scars, fine lines, wrinkles, pigmentation, and overall skin texture, resulting in smoother, firmer, and more youthful-looking skin.

Risks of Micro-needling

While microneedling is considered a safe and minimally invasive procedure, it carries some risks. I understand that possible side effects may include:

• Infection: Though rare, viral, bacterial, or fungal infections can occur whenever the skin is compromised. I must contact the clinic immediately if I notice signs of infection.

• Pigment/Color Changes: Because the treatment penetrates the skin, there is a risk of hyperpigmentation or hypopigmentation. Avoiding sun exposure and using daily SPF 30+ sunscreen after treatment are essential.

• Scarring: Although uncommon, abnormal scars such as keloids may form, particularly if I am prone to scarring or fail to follow aftercare instructions.

• Pain/Discomfort: A temporary burning, stinging, or scratching sensation is expected during or after treatment. Redness or swelling may last several days.

• Persistent Redness/Swelling/Itching: These are normal healing responses, usually resolving within a few days, though symptoms may last longer in rare cases.

• Allergic Reaction: Since microneedling increases skin absorption, reactions to topical products used during or after treatment may occur.

• Unsatisfactory Results: I understand that results vary, multiple treatments may be needed, and no outcome can be guaranteed.

Current Skincare/Treatments/Medications we should be aware of?

I acknowledge the importance of disclosing all medical conditions and medications to my massage therapist and informing them of any changes. I understand that additional risks may arise based on my physical condition

I take responsibility for communicating any discomfort experienced during the massage session so that adjustments can be made accordingly.

Client Acknowledgment

By signing below, I confirm that:

• I have disclosed all relevant medical information and medications.

• I understand the risks, benefits, and possible side effects of microneedling.

• I will follow all post-care instructions, including avoiding sun exposure, tanning, and harsh skincare products, and using sunscreen as directed.

• I understand that results vary and multiple sessions may be required.

• I release Ju-ene, any of its staff, and practitioners from liability for adverse outcomes if I fail to follow instructions or disclose relevant information.

Photography Consent

• I consent to photos being taken before and after treatment for my confidential record.

I give permission for de-identified photos (no name or personal details) to be used for education/marketing.

Yes

Refund Policy

I understand that treatment fees cover staff expertise, equipment use, and products. For this reason, all treatments are non-refundable, regardless of the outcome.

Client Representative/Witness

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