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Home
Treatments
Skin Treatment
The Boon Method Signature Facial
Signature Holistic Skin Reset Facial
Nervous System Reset Facial
Advanced Skin Renewal (Microneedling)
Skin Smooth & Glow (Dermaplaning Facial)
Skin Resurfacing Peel (Chemical Peel)
Face Sculpt & Fascia Release
Face Lymphatic Drainage Massage
Signature Face, Neck & Head Healing Therapy
Massage Treatments
Lymphatic Drainage Massage (Body)
Myofascial Release Therapy (Face & Upper Body)
Head Healing & Nourishing Oil Therapy
About Us
Reviews
Blog
Contact us
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Microneedling Consultation & Consent Form
Please complete this form before your appointment.
Client Details
Full name
Date of birth
Mobile number
Email address
Address
Emergency contact name
Emergency contact number
GP name and surgery
Medical History (Please tick everything that applies.)
High blood pressure
Low blood pressure
Heart condition or heart failure
Diabetes
Kidney disease
Liver disease
Thyroid condition
Autoimmune or inflammatory condition
Cancer, current or previous
Blood clotting disorder or DVT
Taking blood-thinning medication
Epilepsy
Asthma
Pregnant or breastfeeding
Allergies
Recent illness, infection or fever
None of the above
Please give details of any conditions selected above
Current medication, supplements or injections
Allergies or sensitivities
Previous operations, hospital treatment or relevant medical history
Skin and Treatment History
Skin and Treatment History
Active acne or inflamed breakouts
Cold sores or herpes simplex
Eczema, psoriasis, rosacea or dermatitis in the treatment area
Open wounds, infection or sunburn
History of keloid or hypertrophic scarring
Poor wound healing
Loss of sensation or neuropathy
Recent facial surgery
Recent dermal fillers
Recent anti-wrinkle injections
Recent chemical peel, laser or resurfacing
Roaccutane/isotretinoin use
Radiotherapy or chemotherapy
Use of topical retinoids or strong exfoliating acids
Permanent makeup in treatment area
None of the above
Date of last facial, peel, laser or microneedling treatment
Date of last filler or anti-wrinkle treatment
Current skincare products, including retinoids, acids or prescription creams
Main skin concerns and treatment goals
Treatment Area and Assessment
Face
Neck
Décolletage
Scalp
Scarring
Other
Areas to avoid, active lesions or concerns
Therapist skin assessment
Needle depth / device setting
Products or sterile solutions used
Microneedling Consent
Microneedling creates controlled micro-channels in the skin. Temporary redness, warmth, tightness, swelling, pinpoint bleeding, bruising, dryness and flaking may occur. Less common risks include infection, cold-sore reactivation, prolonged irritation, pigmentation changes or scarring.
I confirm that the information I have provided is accurate and complete.
I understand the expected reactions, possible risks and that results cannot be guaranteed.
I agree to follow the aftercare advice and contact BOON if I experience an unusual or concerning reaction.
I consent to microneedling treatment.
Photo and Data Consent
Photo and Data Consent
I consent to photographs being taken for confidential treatment records.
I consent to anonymised photographs being used for education or marketing.
I consent to BOON securely storing my consultation and treatment records in line with UK GDPR.
Digital Signature and Treatment Record
Client full name as digital signature
Date
Treatment notes
Aftercare given
Therapist name / signature
Treatment date
Submit Details
