Botox Therapy Consent Form Page 2

ADVERTISEMENT

Limitations and Alternatives
Botox® is best at treating dynamic facial lines, those caused by facial muscle activity; lines present at rest may or
may not improve. A treatment may be effective for variable lengths of time with subsequent treatments, may not
work as well or for as long as expected, or may not work at all. I have been informed of other alternatives which
exist for the treatment of wrinkles such as topical creams, chemical peels, laser treatments, surgical removal of the
frown muscles, forehead/brow lift, facelift, collagen or hyaluronic acid treatments. Initials: _____
Cost/Fees
Payment for this cosmetic procedure is my responsibility. I understand that there will be an additional fee for
touch ups. Initials: _____
I have read the above and understand it. My questions have been answered satisfactorily by the
doctor and doctor’s associates. I accept the risks and complications of the procedure.
Patient Signature:__________________________________ Date:________________ Time:________________
7942.BotoxConsent
Page 2 of 2

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2