Welcome.

PDRN Salmon Treatment
Intake and Consent Form

You will be receiving the PDRN Salmon Microneedling or Nano Needling treatment, which combines the powerful healing properties of Platelet-Rich Deoxyribonucleic Acid (PDRN) derived from salmon sperm and advanced microneedling/nano needling technology. This procedure promotes collagen production, skin rejuvenation, and reduces the appearance of fine lines, acne scars, and skin texture irregularities.

Expected Benefits:

Skin rejuvenation
Improved skin texture
Reduction in fine lines and wrinkles
Increased hydration and radiance
Smoothing of acne scars or hyperpigmentation

Name

First Name

Last Name

Date Of Birth

Phone

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Emergency Contact

Are you okay with Paige taking photos that she could share for marketing purposes?

OMG, of course!

No, thank you.

Do you have any known allergies (medications, foods, shellfish)?

Please answer the following questions to the best of your knowledge:

Potential Risks and Side Effects

While PDRN Salmon Treatments are generally safe, there are potential risks and side effects, including: - Redness and swelling in the treated area for 1-2 days - Mild bruising (rare) - Dryness, tightness, or peeling (common in microneedling) - Temporary skin sensitivity - Infection (rare with proper aftercare) - Hyperpigmentation (rare, but possible with improper aftercare)

Contraindications (Do not undergo this treatment if you have any of the following conditions):

- Pregnancy or breastfeeding - Active skin infections (herpes, acne, eczema, etc.) - Blood disorders or clotting issues - Use of Accutane within the last 6 months - Allergies to salmon or related products - Active cancer or skin malignancies - Open wounds, rashes, or sunburn in the treatment area

Aftercare Instructions:

- Avoid direct sun exposure for 48 hours after treatment. - Apply gentle, hydrating products and sunscreen (SPF 30 or higher) daily for at least 1 week. - Do not pick or peel any flaking skin. - Avoid strenuous exercise or excessive sweating for 24-48 hours. - Hydrate your skin with a gentle moisturizer and drink plenty of water.

Consent and Acknowledgement:

I understand that the PDRN Salmon Microneedling or Nano Needling treatment involves the use of a biologic product derived from salmon sperm, and I am not allergic to any components of this treatment. I acknowledge that I have provided accurate information regarding my medical history and skin conditions. I have discussed my treatment options with the provider and have had the opportunity to ask any questions. I understand that results may vary, and multiple treatments may be required for optimal results. I agree to follow all pre- and post-treatment instructions as provided by my aesthetician to minimize risks and ensure the best possible outcome. By signing below, I consent to undergo the PDRN Salmon Microneedling or Nano Needling treatment. I acknowledge that I have read and understand the information provided in this consent form.

Welcome.

PDRN Salmon Treatment Intake and Consent Form

Follow forSpeical Offers!

PDRN Salmon Treatment
Intake and Consent Form

Follow for
Speical Offers!