Needling/Collagen Induction Therapy Intake

Are you over the age of 18 years?
SKIN TYPE: Review the skin types below, using the Fitzpatrick Scale, and check the one that best describes your skin. This information will be used by your technician to determine the most appropriate way to approach your treatment(s):
Are you of Asian heritage (Class V) and/or have a history of keloid scarring?
Have you had needling or collagen induction therapy in the past?
Are you prone to keloid or hypertrophic scarring?
Have you ever had any of the following injectables or implants?
Have you had any recent cosmetic surgeries/procedures?
Have you used Accutane in the past year?
Do you have hyperpigmentation darkening of the skin or hypopigmentation (tightening of the skin or markes after physical trauma?
Do you have any tattoos in the area to be treated?
Have you had chemotherapy in the past 6 months?
Do you have any of the following condition
Do you have any other health conditions not mentioned here?
Do you have moles/skin growths in the area to be treated?
Have you ever had a reaction at the dentist or any other time from numbing
Have you consumed drugs or alcohol in the last 24 hours?

Thanks for submitting!