Cosmetic filler consent form 2025

Get Form
dermal filler consent form Preview on Page 1

Here's how it works

01. Edit your dermal filler consent form online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send dermal consent form via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out cosmetic filler consent form with our platform

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2
  1. Click ‘Get Form’ to open the cosmetic filler consent form in the editor.
  2. Begin by reviewing the treatment information provided. This section outlines the benefits and potential risks associated with Hyaluronic Acid Dermal Fillers.
  3. Fill out the 'Pregnancy, Allergies and Health History' section honestly. Ensure you check all applicable boxes regarding your health status and any allergies.
  4. In the 'Cost/Fees' section, acknowledge your understanding of payment responsibilities and any additional fees for touch-ups. Make sure to read this carefully as it outlines important financial obligations.
  5. Review the 'Post Care' instructions thoroughly. Confirm that you understand the aftercare requirements to ensure optimal results post-treatment.
  6. Finally, sign and date the form at the bottom. Ensure both patient and provider signatures are completed for validation.

Start using our platform today to complete your cosmetic filler consent form easily and for free!

See more cosmetic filler consent form versions

We've got more versions of the cosmetic filler consent form form. Select the right cosmetic filler consent form version from the list and start editing it straight away!
Versions Form popularity Fillable & printable
2022 4.8 Satisfied (42 Votes)
be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
Unlike Botox, which requires a prescription from a qualified medical professional, anyone can legally administer dermal fillers. This has resulted in a proliferation of unqualified practitioners offering treatments with limited or no medical training.
Informed consent language should be written in the second person (you), not in the first person (I). Minimize passive voice to the extent possible. Example of passive voice: A summary of results will be sent to all study participants. Example of active voice: We will send you a summary of the results.
In California, for example, licensed physicians are the only ones who can administer Botox and fillers without supervision.
Patients under 18 may be able to receive filler with parental consent, but reputable injectors may refuse treatment until the patient is of age. EllEve Med Spa provides lip fillers to patients in Woodland Hills, San Fernando Valley, Los Angeles, California, and surrounding communities.
In many jurisdictions, the administration of lip fillers is considered a medical procedure and therefore falls under the purview of healthcare professionals. Generally, this means that individuals who are not registered nurses may not legally perform lip filler procedures.

Key Facts About the Dermal Filler Consent Form

Treatment Purpose

Risks Involved

Health Requirements

Financial Responsibility

Post-Treatment Care

Consent Validity

Documentation Authorization

Treatment Purpose

Hyaluronic Acid Dermal Fillers are used to smooth out wrinkles, add volume to facial features, and contour areas affected by aging or other factors.

Risks Involved

Potential risks include bruising, nodules, migration of filler, infection, allergic reactions, and accidental injection into blood vessels.

Health Requirements

Patients must not be pregnant, breastfeeding, or have major illnesses such as autoimmune issues or active cancer to qualify for treatment.

Financial Responsibility

Patients are responsible for all costs associated with the procedure, including additional fees for touch-ups and no refunds for elective treatments.

Post-Treatment Care

Post-care instructions include avoiding makeup for 12 hours and strenuous exercise for 48 hours after treatment.

Consent Validity

The consent form remains valid until revoked in writing by the patient and applies to all future filler injections.

Documentation Authorization

Patients authorize clinical photographs for documentation purposes as part of the treatment process.

be ready to get more

Complete this form in 5 minutes or less

Get form

People also ask

What qualifications do you need to be certified to administer cosmetic injections such as Botox or dermal fillers? Meet the requirements for injecting cosmetic injectables Only a licensed doctor, physicians assistant, nurse, or other medical professional is permitted to administer cosmetic injectables.
In cosmetic surgeries, taking an informed consent is based upon the patients autonomy. The reason for consent is information and understanding of a patient about treatment modalities and finally choosing one of the several options for treatment.

dermal consent