Consent form 2025

1. Click ‘Get Form’ to open the consent form in the editor.
2. Begin by reviewing the 'Proposed Treatment' section. Initial next to this section to confirm your understanding of the Xeomin injection process.
3. Move on to the 'Anticipated Benefit' section. Here, initial to acknowledge that you understand the expected results and potential need for follow-up treatments.
4. In the 'Risks and Complications' section, read through the possible side effects carefully. Initial after you have understood these risks.
5. Proceed to 'Pregnancy & Neurological Disease'. Confirm that none of these conditions apply to you by initialing this section.
6. Review 'Limitations and Alternatives'. Initial here to indicate that you are aware of other treatment options available.
7. In the 'Costs/Fees' section, initial to accept your responsibility for payment and any additional fees for touch-ups.
8. For 'Follow-up', initial if you agree to a follow-up appointment as instructed by your physician.
9. Finally, in the 'Photographs' section, initial to authorize clinical photographs for scientific purposes while ensuring your identity is protected.
10. Sign and date at the bottom of the form, along with printing your name and having a witness sign if required.

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