Botox and Filler Consent form

 

If none, type none.
If none, type none.
If none, type none.
Sign Here, write "No" for no consent to Botox injections
Sign Here, write "NO" for no consent to electronic communications
Sign Here, write "NO" for no consent to electronic communications
Sign Here, write "NO" for no consent to treatment
Sign here, write "No" for no consent to Lidocaine Nerve Block

 

Updated 8/16/2020