Botulinum Toxin Hyperhydrosis Consent Form
Date of Birth:
Hyperhidrosis Informed Consent
Botox® is indicated and licensed for the treatment of severe primary axillary hyperhidrosis that is inadequately managed with topical agents. Its safety and efficacy have not been established for the treatment of hyperhidrosis on the hands, feet, scalp or face.
Botulinum toxin injection is generally a safe and effective treatment method. Nevertheless, certain side effects can occur;
Common Side Effects Associated with the Injection Include
Pain or stinging sensation when the injection is performed.
Localised swelling, redness, tenderness
Bleeding at the sites of injection
Numbness or itching of the area following injection.
The above usually resolve spontaneously within hours or days, but may persist for longer.
Rare Side Effects (3-10%) Include
Compensatory sweating from other areas of the body.
Aching or weakness in the upper arms, which is temporary
Neck or back pain
Allergic reactions have not been reported with this treatment; Symptoms of allergy include; itching, rash, red itchy welts, wheezing, asthma symptoms, dizziness or feeling faint. Get medical help immediately if you have any breathing problems.
Weakness of hand muscles and drooping of the eye lids may occur in patients who receive BOTOX ® for palmar hyperhidrosis and facial hyperhidrosis, respectively.
In general, adverse reactions occur within the first week following injection and while generally temporary, may have a duration of several months, or longer.
Successful treatment can significantly reduce sweating in the treatment area for a period of 6-12 months. The successful outcome varies by degree and how long it lasts from one individual to another and cannot be guaranteed. Treatment may be repeated once the therapeutic effect has worn off.
On occasion it is helpful to share visual images of our own treatment results.
I consent to photographs being published for;
I have been advised the cost of the treatment will be £ and accept the terms of payment as per the clinic policy (terms and conditions).
Leave this empty:
Signed by Nina Bal
Signed On: 8th January 2020
If you have questions about the contents of this document, you can email the document owner.
Document Name: Botulinum Toxin Hyperhydrosis Consent Form
Agree & Sign