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Botox Consent
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I understand that there is a possibility of adverse events following this procedure as described in the Botulinum Toxin Type A product insert.
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Laser 1320 Consent
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This form is intended to provide you with the information needed to make an informed choice on whether or not to undergo 1320nm laser skin rejuvenation. If you have any questions, please do not hesitate to ask us.
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Laser Hair Removal Consent
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I, _________________________________ hereby duly authorize Allure Aesthetic Skin Center, physician, healthcare professional, or surgeon in charge, together with specially trained technicians or such assistants as he/she may designate to perform the special hair removal procedures using light-based therapy methods.
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Mesotherapy/Lipodissolve Consent
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I understand that Mesotherapy is a cellulite treatment which involves a customized mixture of FDA-approved medications, vitamins, amino acids, enzymes and homeopathic ingredients injected beneath the skin to break down cellulite and connective tissues and improve circulation. Lipodissolve is a form of Mesotherapy, used for reserved fat areas, which has shown the ability to dissolve fat cell membranes, and is considered a safe alternative to liposuction. Cosmetic indications for these procedures include cellulite removal, treatment of problem fat areas, gynecomastia, skin rejuvenation, eye pad fat removal, and facial sculpting. Each treatment takes approximately 15-30 minutes depending on the site, and may be used alone or in combination. You may experience soreness and signs of inflammation after treatments, but will be able to return to all normal activities.
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Microdermabrasion Consent
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To the CLIENT: You have a right to be informed about your condition and it’s treatment, so that you make the decision whether or not to undergo the procedure after knowing the risks and hazards involved. This disclosure is not meant to scare or alarm you; it is simply an effort to make you better informed so you may give, or withhold, your consent for treatment
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Photorejuvenation for Acne
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I, ________________________________ hereby duly authorize Allure Aesthetic Skin Center, physician, healthcare professional, or surgeon in charge, together with trained technicians or such assistants as he/she may designate to perform the procedures using a multi-application photo therapy system for the treatment of mild to severe inflammatory/non-inflammatory Acne Vulgaris for all skin types.
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Photorejuvenation for Vascular/Pigmented Lesions Consent
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I, _________________________________ hereby duly authorize Allure Aesthetic, Physician, healthcare professional, or surgeon in
charge, together with trained technicians or such assistants as he/she may designate to perform the procedures using photorejuvenation
treatment (s) on me for the treatment of but not limited to the following skin conditions: Rosacea, Poikiloderma, Telangectasias (spider
veins), Sun Damage, Age & Liver Spots, Freckles, Melasma and Rhytides (fine lines and wrinkles).
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Restylane® or Juvéderm Consent
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As my patient, you have requested my administration of Restylane or Juvederm; a stabilized hyaluronic acid used in the correction of moderate to severe facial wrinkles and folds. All medical and cosmetic procedures carry risks and may cause complications. The purpose of this document is to make you aware of the nature of the procedure and its risks in advance so that you can decide whether or not to go forward with the procedure.
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Sclerotherapy Consent
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This form is designed to provide you with the information you need to make an informed decision about whether to have Sclerotherapy performed. If you have any questions or do not understand any potential risks, please do not hesitate to ask us.
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