Consent for Botox Cosmetic® Treatment

  • 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.








  • Date Format: MM slash DD slash YYYY

  • *Botox Cosmetic® is a registered trademark of Allergan, Inc.

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  • Coral Medical Spa

    1400 Provincial Road, Windsor Ontario,
    Canada N8W 5W1
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