Botox / Neurotoxin Informed Consent

Treatment Overview

Botulinum toxin (e.g., Botox®, Dysport®, Xeomin®) is used to temporarily relax targeted muscles to improve the appearance of lines and wrinkles.

Results are temporary and typically last 3-4 months; individual response varies.

I understand the nature and temporary duration of treatment.Initials

Risks & Side Effects

• Bruising, swelling, redness, pain at injection sites
• Headache or flu-like symptoms
• Asymmetry or uneven results
• Eyelid or brow drooping (ptosis), dry eyes, double vision
• Unintended muscle weakness or diffusion of product
• Allergic reaction or infection (rare)

I understand the risks and potential complications listed above.Initials

Medical Disclosure & Contraindications

• I am not pregnant or breastfeeding (unless discussed and approved by my provider).
• I do not have a known allergy to botulinum toxin products.
• I have disclosed all medical conditions, medications, supplements, and prior reactions.
• I will inform my provider of any neuromuscular disorders or infections at the treatment site.

I have fully disclosed my medical history.Initials

Alternatives & No Guarantee

• Alternatives include no treatment, skincare, laser/energy-based treatments, or surgery.
• No guarantee has been made regarding results; additional treatments may be required.

I understand alternatives and that results are not guaranteed.Initials

Financial Policy

All sales are final. No refunds are provided once treatment has been performed. Touch-ups, if indicated, must be completed within the recommended timeframe.

I understand and agree to the financial policy.Initials

Consent & Signatures