Thank you for trusting Hush Medical Spa with your aesthetic care. This consent form explains the procedure, benefits, and potential risks associated with treatment using botulinum toxin type A products — including Botox®, Dysport®, and Jeuveau® — so you can make an informed and confident decision.
Botulinum toxin type A is a purified protein that temporarily relaxes targeted facial muscles, reducing the appearance of dynamic wrinkles caused by facial expressions. Common treatment areas include:
The procedure typically takes 15–20 minutes. A fine needle delivers precise injections, often experienced as a mild pinch or slight burning. Results generally begin to appear within 2–10 days, depending on the product used, and typically last 3–5 months. With regular treatments, longevity and effectiveness may improve.
While botulinum toxin treatments are widely used and generally safe, possible side effects include but are not limited to:
I authorize Hush Medical Spa to take clinical photographs for documentation, educational, and scientific purposes. My identity will be protected in any use outside my medical record.
I confirm that:
I understand this is a cosmetic procedure and agree that payment is my responsibility.
I understand that treatment with botulinum toxin type A products may temporarily reduce my ability to frown or form certain expressions, and that these effects are fully reversible over time. I also understand that in rare cases, results may be less effective or shorter-lasting than anticipated. I agree to remain upright and avoid massaging or manipulating the treated areas for at least four hours post-treatment.
I have read and fully understand this consent form. All of my questions have been answered to my satisfaction, and I freely consent to treatment with Botox®, Dysport®, or Jeuveau® for the management of facial dynamic wrinkles.
Client Signature ____________________________________ Date ____________
Witness Signature ___________________________________ Date ____________