Dermal Filler Consent Form
I agree to receive injections of Filler/ Hyaluronic acid for the purpose of dermal smoothing and filling or augmentation from Refresh Evolution.
The objectives and methods of the injection procedure have been clearly explained to me by the practitioner.
- I have received, read and understood the information sheet supplied by the practitioner or on behalf of Refresh Evolution, prior to the injection. I had the opportunity to ask any necessary questions.
- I understand the pre- and post-injection recommendations and I agree to follow them.
- I acknowledge that I had the time required for consideration and to make my decision.
- I acknowledge that I have been clearly informed of the side-effects and the rare cases of medical device vigilance.
- I freely and voluntarily consent to receiving injections.