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  • Dermapen Consent Form

Get Dermapen Consent Form

Treatment Consent Clinic/Salon: Patients Name (BLOCK LETTERS Address : Email: Mb Tel : Please circle or answer where appropriate: Do you have any current or chronic medical illnesses we should know.

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How to fill out the Dermapen Consent Form online

Completing the Dermapen Consent Form online is an important step to ensure your safety and understanding before undergoing treatment. This guide will walk you through the necessary sections of the form, providing you with the guidance needed to fill it out accurately.

Follow the steps to complete the Dermapen Consent Form online.

  1. Click the ‘Get Form’ button to access the Dermapen Consent Form and open it in a digital editor.
  2. In the first section, provide the name of the clinic or salon where you will receive treatment.
  3. Fill in your name in block letters, ensuring clarity and legibility.
  4. Enter your address, including street, city, state, and zip code.
  5. Include your email address and mobile telephone number for contact.
  6. Answer the health-related questions by circling 'Yes' or 'No' where appropriate. Be clear with any conditions you may have.
  7. List any current medications, herbal or natural supplements, and any previous surgeries when prompted.
  8. Respond to questions regarding allergies, skin sensitivity, and various skin conditions accurately.
  9. In the section regarding sun history, indicate your recent sun exposure and reactions.
  10. Answer questions about your ability to heal, scarring tendencies, and skin type thoroughly.
  11. Review the risks and benefits section to understand the treatment implications.
  12. Sign the form to give your consent, entering the date to confirm your understanding and acceptance.
  13. Lastly, consider the photography and video release section, checking the appropriate boxes and signing as needed.
  14. After completing all the sections, you can save your changes, download the form, print it for physical records, or share it as required.

Complete your Dermapen Consent Form online to ensure a smooth treatment process.

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Medical-Grade Skin Needling (Dermapen) is suitable for most people, if you have severe acne we may suggest starting on other treatments first.

The Dermapen 4™ Medical delivers effortless and effective skin needling. This is an FDA-approved microneedling device for medical treatment by a qualified practitioner.

Microneedling can cause bleeding so it may not be suitable for people with clotting or bleeding disorders, or who take medicine to thin their blood. You may want to avoid microneedling if you have conditions that affect your skin, such as eczema or diabetes, or if you have a weakened immune system.

What are the benefits of microneedling devices? The FDA has cleared microneedling devices for use on women and men aged 22 and older as a treatment to improve the appearance of: Acne scars on the face. Wrinkles around the eyes and other parts of the face and neck.

The TGA issued three infringement notices for the following alleged contraventions of the Therapeutic Goods Act 1989 : Section 41MIB(1)(a)(iii) - supply of Dermapen 4 (medical device) not included in the ARTG. Two infringement notices issued for offences on 22 February 2019 and 17 May 2019.

What's the difference between the Dermapen and the microneedling? Both treatments are the same. But the Dermapen is “The pen” with which the microneedling treatment is performed. The treatment with the Dermapen is the most modern, most popular and safest microneedling treatment.

The FDA has legally authorized microneedling devices to improve the appearance of facial acne scars, facial wrinkles, and abdominal scars in patients aged 22 years or older.

The SkinPen® Difference There are many microneedling devices on the market from rollers to smaller at-home devices, but only the SkinPen has been approved by the FDA. A number of risks have been uncovered involving the use of non-FDA-approved devices.

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