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Consent Form for Botulinum Toxin Type A
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I confirm that I consent to receiving treatment using Botulinum Toxin Type A.
I have been given sufficient information to enable me to understand the product.
I understand there is a risk of possible: Bruising, bleeding, redness, swelling and discomfort and more rare: headaches, drooping eye lid, localised muscle weakness and long term facial pain.
I understand more rare side effects can be: infection, anxiety, numbness, dizziness, inflammation of the eyelid, eye pain, visual disturbance, facial palsy and deafness due to nerve damage.
I understand the possible risks with Botulinum Toxin Type A.
I agree to the post treatment advice given by my practitioner.
I understand that the practice of medicine and surgery is not an exact science and therefore no guarantee can be given as to the results of the treatment referred to in this document. I accept and understand the goal of this treatment is improvement, not perfection, and there is no guarantee that the anticipated results will be achieved.
I understand no procedure is risk free.
I understand that in the case of a complication that I would need to attend Be You Aesthetics for a face to face review.
I have had the procedure, risks, possible side effects explained to me.
I have had the chance to ask my practitioner any questions.
I understand Botulinum Toxin Type A can have rare complications that may require an opinion of a plastic surgeon or neurologist for which Be You Aesthetics Leeds Limited will not be liable for.
Whilst more serious complications are very rare, I understand that Be You Aesthetics / Be You Medical Group will not be held liable. They have explained that they will always offer the most honest and expert advice should anything untoward arise as a result of treatment.
I consent I have provided honest and truthful information to my practitioner.
I agree that after treatment I will avoid alcohol consumption, strenuous physical activity for 24 hours post treatment
I understand I cannot lay down for 4 hours post treatment.
I consent to the use of photography and understand my photos may be used for marketing and social media.
I understand a complimentary review may be offered to me 2-3 weeks post treatment. If I fail to attend this review or do not provide 48 hours notice or more to reschedule I will not be offered a further complimentary appointment.
I understand that Be you Aesthetics / Be You Medical Group holds a no refund policy regardless of the circumstances
I am aware of the Be You Aesthetics Leeds Privacy Policy and understand that personal information may be passed onto a third party when necessary.
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IMPORTANT INFORMATION FOLLOWING BOTULINUM TOXIN TYPE A TREATMENT
Do not bend excessively or lay flat for at least 4 hours
Do not exercise for 24 hours
Avoid saunas, sunbeds, steam rooms, facials, skin peels etc for 2 weeks post procedure
You will not see the full effect of Botulinum Toxin Type A until 2 weeks – if a top up is required please contact us around day 12
Top ups increase the chance of resistance against the toxin so we only advise this if absolutely necessary
Finally, treatment with Botulinum Toxin is temporary and to maintain the effects, treatment is recommended every 3 to 6 months. Doing so, acts as a preventative for fine lines and wrinkles.
Do not hesitate to contact our medical team on - 0113 4501646 should you have any queries.
