Microneedling Consent Form

A copy of this completed consent form along with post treatment advice will be emailed to the email address you provide below.


    • I have completed the microneedling treatment consultation and consent form honestly and to the best of my knowledge.
    • I understand what a microneedling treatment is and how it works, I also understand the expected outcomes of my microneedling treatment. I understand the microneedling treatment contraindications and considerations. I understand the anaesthesia protocols pros and cons. I understand post op care is my responsibility.
    • I understand that results will vary between individuals due to the natural variation in the quality of Collagen and Elastin. I understand that although I may notice a change after my first treatment, I may require a series of up to six sessions to achieve my desired outcome.
    • I understand that while good results are expected, complications are possible, and their nature cannot be fully anticipated. Therefore, no guarantees, expressed or implied, have been made regarding the success or outcome of the treatment. I am aware that the effects of microneedling treatment are not permanent, as natural degradation will occur over time.
    • I authorise Qaya Clinic to perform the microneedling treatment with the Dermapen 4 or any other microneedling device.
    • I have had the opportunity to ask questions about the treatment, including its risks and alternatives. All my questions have been answered to my satisfaction.