This is an informed consent document that has been prepared to help inform you concerning Anti-wrinkle injections and the risks involved. It is important that you read this information carefully and completely.
Please complete each section, indicating that you have read the page and sign the consent at the bottom prior to your treatment.
INTRODUCTION: Anti-Wrinkle injections involve a series of small injections in order to weaken the chosen muscles. The weakening of the injected muscles begins to be apparent after 2-3 days with the peak effect being reached after 10-14 days. Results can last 3-6 months. The procedure can be repeated after 3 months; however, injections given less than 3-month intervals may reduce the efficacy of the injections.
RISKS OF ANTI-WRINKLE INJECTIONS: Every procedure involves a certain amount of risk, and it is important that you understand the risks involved. An individual's choice to undergo a procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience these complications, you should discuss each of them with your practitioner to make sure you understand the risks, potential complications, and consequences of Anti-Wrinkle injections: Bleeding, Bruising/Swelling, Infection & Unsatisfactory Outcome/Temporary loss of function of nearby muscles.
PUBLICITY MATERIALS I authorise the taking of clinical photographs and videos. I understand that photographs and video may be taken of me for educational and marketing purposes. I hold the practitioner harmless for any liability resulting from this production. I waive my rights to any royalties, fees and to inspect the finished production as well as advertising materials in conjunction with these photographs. You certify by signing this form that you have read the information in this document and completely understand it. You choose to proceed based entirely on the information provided in this informed consent document. You have been given all the necessary opportunities for discussion and all your questions regarding anti-wrinkle injections have been answered. You therefore and hereby consent to the care or treatment described herein. Any discrepancies must be taken up with the practitioner within 1 month of treatment.