I am aware that when a small amount of purified neurotoxin (BOTOX®) is injected into a muscle, it causes weakness or paralysis of that muscle. This appears in 2 weeks and usually lasts 3-4 months but can be shorter or longer. Results and Post-Operative Care I understand that I will not be able to move the treated muscle(s) while the injection is effective but that it will reverse itself after a period of 3-4 months, at which time another treatment is appropriate. I understand that I must stay in the erect posture and that I must not manipulate the area of the injection site for the four-hour post-injection period. Risks and Complications The treatment of frown lines with neurotoxins can cause minor temporary droop of one eyelid in approximately 2% of injections. This usually lasts 2-3 weeks. Occasional numbness of the forehead lasting 2-3 weeks, bruising and transient headache has occurred. In a very small number of individuals, the injection does not work as satisfactorily or for as long as usual. Photographs I authorize the taking of clinical photographs for the purpose of assessing my treatment outcome. I understand my identity will be protected. Pregnancy and Neurologic Disease I am not aware that I am pregnant or that I have any significant neurologic disease. Payment I understand that this is a cosmetic procedure and that payment is my responsibility. I understand that once I’ve had my treatment there are NO REFUNDS and NO GUARANTEES.Consent* I have read the above and understand it. My questions have been answered satisfactorily by the doctor and nurses. I accept the risks and complications of the procedure.Name* First Last Date Date Format: MM slash DD slash YYYY Signature**Botox Cosmetic® is a registered trademark of Allergan, Inc.