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Medical Aesthetics Bar

Neurotoxins (Botox, Dysport, Xeomin, and more.)

Consent Form

Client Information

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Health & Medical History Please check all that apply:

Treatment Description — Neurotoxins

Neurotoxins such as Botox, Dysport, Xeomin, and others are injectable treatments used to temporarily:

  • Reduce the appearance of fine lines and wrinkles

  • Smooth dynamic facial lines caused by muscle movement (e.g., frown lines, crow’s feet, forehead lines)

  • Provide a subtle lift and refreshed facial appearance

These treatments work by relaxing targeted muscles to improve the appearance of wrinkles and prevent new lines from forming. Effects typically last 3–6 months, depending on individual factors and treatment area.

Pre-Treatment Recommendations

  1. Avoid blood-thinning medications (e.g., aspirin, ibuprofen) for 24–48 hours prior, unless cleared by your physician.

  2. Avoid alcohol consumption for 24 hours prior to reduce bruising risk.

  3. Avoid facial treatments (chemical peels, microneedling, laser) in the treatment area for 1–2 weeks prior.

  4. Disclose all medications, allergies, or medical conditions.

  5. Arrive with a clean face, free of makeup or skincare products.

Post-Treatment Recommendations

  1. Do not rub, massage, or apply pressure to treated areas for at least 24 hours.

  2. Avoid intense exercise, saunas, or hot baths for 24 hours.

  3. Remain upright for at least 4 hours post-treatment.

  4. Avoid blood-thinning medications or alcohol for 24 hours post-treatment to minimize bruising.

  5. Avoid facial treatments or laser procedures in treated areas for 1–2 weeks unless approved by your provider.

  6. Results may take 3–14 days to appear; follow-up may be scheduled for adjustments if necessary.

  7. Report unusual side effects (severe swelling, drooping, asymmetry, difficulty swallowing or breathing) immediately.

Consent & Liability Acknowledgment

I, the undersigned, acknowledge and agree that:

  1. I am voluntarily receiving neurotoxin treatment at Medical Aesthetics Bar and fully understand its purpose, benefits, and potential risks.

  2. I have provided complete and accurate medical history, including allergies, medications, pregnancy status, and previous procedures.

  3. Results vary by individual, and no guarantees or warranties are made regarding outcome or duration.

  4. I have read, understood, and agree to follow all pre- and post-treatment recommendations.

  5. I release, indemnify, and hold harmless Medical Aesthetics Bar, its owners, employees, and contractors from any liability, claims, or damages arising from the treatment, except in cases of gross negligence or willful misconduct.

  6. Photographs may be taken for documentation, treatment comparison, or educational purposes, with my consent while maintaining confidentiality unless otherwise authorized.

  7. I will notify Medical Aesthetics Bar immediately if I experience unexpected complications or concerns.

Acknowledgment:

  • Photographs may be taken for documentation, treatment comparison, or educational purposes, with my consent while maintaining confidentiality unless otherwise authorized.

  • I will notify Medical Aesthetics Bar immediately if I experience unexpected complications or concerns.

Acknowledgment:

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