1. I have read and received and understood the information that is supplied by my practitioner or on behalf of information sent to me prior to being injected.
2. I have had the opportunity to ask necessary questions.
3. I under stand the pre and post injection recommendations and I agree to follow them.
4. I acknowledge that I had time required for consideration and to make my own decision.
5. I acknowledge that I have been clearly informed of the side effects and the rare cases of medical device vigilance and what to do so in an emergency or reactions.
6. I freely and voluntary consent to all injections.
7. I take full responsibility for having dermal filler injections.
