This informed consent form is to provide written information regarding the risks, benefits, and alternatives of the procedure you are about to undertake. This material serves as a supplement to the discussion you have with your doctor/healthcare/medical provider. It is important that you fully understand this information, so please read this document thoroughly. If you have any questions regarding the procedure, ask your doctor/healthcare professional prior to signing the consent form.
HYPERHIDROSIS treatment involves the use of botulinum toxin injections or other approved methods to reduce excessive sweating in areas such as the underarms, hands, feet, or face. This treatment works by temporarily blocking the nerves that stimulate sweat glands, thereby reducing perspiration in the targeted area.
RISKS AND COMPLICATIONS
Understanding the risks is essential. No procedure is completely risk-free. The following risks may occur, but there may be unforeseen risks and risks that are not included on this list. Some of these risks, if they occur, may necessitate medical attention and/or extended therapy. It has been explained to me that there are certain inherent and potential risks and side effects in any procedure, including but not limited to:
Localized pain, tenderness, or discomfort at the injection site.
Bruising, swelling, or redness at the treated area.
Temporary weakness or fatigue in the treated muscles.
Allergic reaction to the product or components used.
Mild flu-like symptoms.
Asymmetry or uneven results.
Temporary dry skin or compensatory sweating in untreated areas.
Rare complications such as infection, muscle weakness outside the treated area, or nerve damage.
PUBLICITY MATERIALSI authorize the taking of clinical photographs and videos. I understand that photographs and videos 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.
RESULTS
Hyperhidrosis treatments have been shown to be safe and effective in reducing excessive sweating. The effects typically last between 4-12 months, but results may vary depending on individual factors. It is important to note that this is a temporary procedure and repeat treatments will be required to maintain results. There is no guarantee that you will be completely satisfied with the results, and additional treatments may be needed to achieve your desired outcome.
POST-TREATMENT CARE
I have been instructed in and understand the post-treatment instructions. I understand that there may be a downtime period of a few days to one week for the treatment to take full effect and that I may experience some temporary side effects as outlined above.
RIGHT TO DISCONTINUE TREATMENT
I understand that I have the right to discontinue treatment at any time. However, I acknowledge that payment for any treatments administered will still be required in full.
PAYMENT
I understand that this is an elective procedure and that payment is my responsibility and is expected at the time of treatment. I understand that this is a non-essential procedure and the procedure has been fully explained to me.
I certify by signing this form that I have read and understood the information provided in this document. All of my questions have been answered satisfactorily. I accept the risks and complications of the procedure, and I understand that no guarantees are implied regarding the outcome. I also confirm that I will notify my healthcare provider of any changes in my medical history. I certify that I can read and write in English.