RF Microneedling Informed Consent


RF + Microneedling Informed Consent

RF + Microneedling Informed Consent

(Aesthetics)

Date:

Patient Information

  • Patient Name: {{patient_first_name}} {{patient_last_name}}
  • Date of Birth: {{patient_birthdate}}

Treatment Information

I understand that I will be receiving RF (Radiofrequency) + Microneedling treatment, which combines microneedling with radiofrequency energy to stimulate collagen production and improve skin texture, tone, and firmness.

Consent Statements

Please initial each statement:

1. I understand the nature of RF + Microneedling treatment.

2. I understand the potential risks and benefits.

3. I have been informed of alternative treatments.

4. I understand that results are not guaranteed.

5. I will follow all post-treatment instructions.

Medical Services provided by Primary Medical of KY, P.S.C., Elite Health Services, P.A., Co., Primary Medical of IN, P.C.

Form Complete

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Ava Peters
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Luis Escobar
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Signature Certificate
Document name: RF Microneedling Informed Consent
lock iconUnique Document ID: cde95f5d7013c8e917658e44ec29fcdf5ad34a9c
ENNU Patient Docs
Party ID: 99cf213d-eb99-4009-90a9-c0126770f20b
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Ava Peters
Party ID: 1ff37cfd-4118-4aed-8fb8-569baeee74f8
Awaiting signature
Luis Escobar
Party ID: 635e739d-8c7a-4179-b032-76b23dfd6f89
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Timestamp Audit
December 13, 2025 1:56 pm EDTRF Microneedling Informed Consent Uploaded by ENNU Patient Docs - ennu-appointments@ennu.co IP 139.68.242.135
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