Profhilo Consent Form
I have been told that such reactions as redness, oedema, pain and itching may follow treatment, as may an acne like eruption. All these reactions are linked to the procedure itself and usually resolve after few days. I have also been told that lumps, abscesses and indurations – sometimes associated with redness and / or swelling – have been reported after treatment in some patients. In most cases, these side effects disappeared, however in some cases, they have lasted up to two weeks. I was also informed about very rare cases, as described in literature, of discolouration at the injection point, necrosis of glabellar area and hypersensitivity after hyaluronic acid injections. All side effects must be reported to the practitioner as soon as possible.
Patients who have had herpes simplex (cold sores) in the past should note that there is always a risk that injecting any product around the lip area and/or previously affected areas may cause the herpes to flare up again.
I understand that the result of the treatment is variable and that the outcome of the treatment cannot be guaranteed.
After treatment, I will follow the advice given by my practitioner to achieve satisfactory aesthetic results. I realise if I do not follow this advice, the end result may be less optimal. I am aware of the importance of follow-up care and my own responsibility.
How and when IBSA’s products should be used, the applicable contraindications and possible undesirable effects have been explained to me. I have replied in all honesty to all questions about my medical and aesthetic history.
I have been given the chance to ask all the questions I wanted and I have received satisfactory replies to all of them. Now that the procedure has been fully explained to me, I consent to have the appropriate injectable treatment.
I declare that the information I have given is true and correct and that as far as I am aware I can undertake the treatment.
I have been fully informed about contraindications, treatment procedure, guidelines, limitations and aftercare. All my questions have been answered fully and therefore I am willing to proceed.
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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: Profhilo Consent Form
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