Botox Consent form

This page explains our terms of service FOR THE botox TREATMENT, which contain important information.

When you book a botox appointment or PACKAGE with the Beautyholic bar, you’re agreeing to these terms AND ARE AWARE OF ANY RISKS.

YOU NEED ONLY FILL/SIGN THIS FORM ONCE.

The purpose of this informed consent form is to provide written information regarding the risks, benefits and alternatives of the procedure named above. This material serves as a supplement to the discussion you have with your service provider. It is important that you fully understand this information, so please read this document thoroughly.

If you have any questions regarding the procedure, ask your service provider professional prior to signing the consent form or email us: inquiries@thebeautyholicbar.com

What is the treatment?

Botox, also known as botulinum toxin type A, is a neurotoxin produced by the bacterium Clostridium botulinum. It is a purified, injectable substance that temporarily paralyzes muscles by blocking the release of acetylcholine, a neurotransmitter that triggers muscle contractions. 

Botox is primarily used for:

  • Cosmetic purposes:

    To smooth out facial wrinkles, such as forehead lines, crow's feet, and frown lines. 

Before the treatment:

Medication review:

Discuss all medications, supplements, and herbal remedies you take with your doctor, as some may increase bruising risk. 

  • Blood thinners:

    Avoid over-the-counter blood thinners like aspirin or ibuprofen a few days before your appointment. 

  • Facial preparation:

    Cleanse your face thoroughly with a gentle cleanser and remove all makeup before arriving at the clinic. 

  • Bruising prevention:

    Consider taking arnica supplements or applying arnica gel topically a few days before your treatment if you tend to bruise easily. 

  • Hydration:

    Drink plenty of water to support your body's healing process. 

  • Alcohol and smoking:

    Avoid alcohol and smoking for at least 24 hours before your treatment. 

  • Exercise:

    Opt for light exercise before your appointment and avoid strenuous activity close to the treatment time. 

  • Communication with your provider:

    Inform your doctor about any concerns or questions you have regarding the procedure. 

I understand the nature of the procedure, including the benefits, risks, and potential side effects. I have provided accurate information regarding my medical history and current skin condition. I acknowledge that no guarantees have been made regarding the results of the treatment. I understand that multiple sessions may be required to achieve optimal results, and maintenance sessions may be needed over time.

I understand this is an elective procedure and I hereby voluntarily consent to the Botox treatment. The procedure has been fully explained to me. I also understand that any treatment performed is between me and the Service Provider who is treating me and I will direct all post-procedure questions or concerns to the treating Service Provider. I have read the above and understand it. My questions have been answered satisfactorily. I accept the risks and complications of the procedure and I understand that no guarantees are implied as to the outcome of the procedure. I also certify that if I have any changes in my medical history I will notify the Service Provider who treated me immediately.

I have read and understand the post-treatment home care instructions. I understand how important it is to follow all instructions given to me for post-treatment care. In the event that I may have additional questions or concerns regarding treatment or suggested home product/post-treatment care, I will consult the Specialist immediately.

I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies, prescription drugs or products I am currently ingesting or using topically. I have read and fully understand this agreement and all information detailed above and I consent to the terms of this agreement. I do not hold Specialist, sonia Felix, or the Registered Nurse & Botox Esthetician, Ashley Paige, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today. I also release any liability that may arise from this procedure.

I also state that I read and write in English.