Botox Injection Consent Form

• Patients with blood diseases are contraindicated to undergo BOTOX injection.
• Patients must stop the following 3 days prior to the procedure:
• Aspirin, brufen, sabofen, multivitamins, vitamin E & green tea

• Pain or burning sensation
• Minimal swelling for 1 to 2 days
• Possible bruise for 2 to 14 days
• Redness
• Possible peeling and pigmentations
• Diabetic patients may experience delayed wound healing on the punctured sites
• Risk of infection due to multiple punctured sites; Fucidin and Bactroban ointment or cream must be applied 3x a day for 5 to 10 days post BOTOX injection.
• No risk of allergic reaction but may develop an allergy due to local anesthesia.
• Visible results will not be immediate.

• You can apply makeup once the wound had healed usually 5 to 10 days. If you want to apply earlier,make sure to use new sponges or brushes.

I certify that I have read and understand the contents of this form and do realize the side effects and limitations involved. I hereby authorize my doctor to perform BOTOX injection and relieve my doctor of the responsibility of any complications.

I understand and agree that I am financially responsible for the payment I made for and that any amount I paid for the sessions or procedures I booked will only be valid up to 3 months from the date I made the payment. I understand that I need to utilize the sessions or procedures within the 3-month period. I agree that my payment made is non-refundable or non-transferable post this period.

I declare that I have read and fully understood all points in this consent and that all of my questions were answered to my satisfaction and I take full responsibility for my decision in this consent.

I, , consent to be photographed and published on Social media, by while before and after the procedure. I further authorize that the photographs may be published for any purpose and in any form