Hyaluron Pen Treatment Consent Form

A risk acknowledgement sheet for needle-free lip and skin treatments with hyaluronic acid. The client ticks each possible reaction, from swelling and bruising to colour change and asymmetry, then signs with the appointment date and contact details. Aesthetic technicians file it before every session.

Use this template

Read each point below and confirm you understand the risks of the treatment.

Pain and tenderness at or around the treated area that typically resolves within a few days to a week.

I have read and understand this

Itching, redness and swelling at or around the injection site may occur. This is a normal reaction that appears right after treatment and clears within a few days or up to a week. Some clients experience prolonged swelling, tenderness or pain at the site for several weeks.

I have read and understand this

In rare occasions, pustules (acne-like lesions) may form.

I have read and understand this

Persons taking medications have a higher risk of bruising and bleeding.

I have read and understand this

Infection may happen at the treated area

I have read and understand this

In very rare cases, hyaluronic acid entering a blood vessel can block blood flow in the treated area or in distant areas and cause tissue damage

I have read and understand this

Grayish discoloration on the treated area of the skin.

I have read and understand this

Asymmetry, where the correction on one side may be different from the correction on the other side of the face

I have read and understand this

Client declaration and authorisation

Date

Name

Nombre

Apellido

Phone Number

Signature

Sign here

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