DATE PROTECTION
In accordance with the United Kingdom date protection Act 1998 we hereby inform the applicant that the personal date provided will be incorporated into a file of date:
The clinic/salon/ aesthetic practitioner is responsible for the relayed information using them for the sole purpose of managing the contracted treatment and send commercial information regarding cosmetic injectables.
The aesthetic practitioner is responsible for using is as for the sole purpose of carrying out the contracted treatment.
The interested party may exercise their rights of access, rectification, opposition and cancellation by sending certified mail to the person responsible.
POSSIBLE RISKS
Discomfort/swelling
After each treatment some swelling redness and tenderness in the treated area can occur, some discomfort is likely to be experienced.
Infection
Infection is unusual the area treated. This must be kept clean and only freshly cleaned hands should touch the areas. See ‘aftercare’ sheets for instructions
on care.
Lumps / irregularities
Injectable using anti wrinkle product may cause bumps which subside shortly after procedure, for lip filler procedures you may experience lumps and bumps for which your aesthetic practitioner will advise on how to deal with them.
Anaesthetic
Topical anaesthetics are used to numb the area to be injected with filler for some aesthetic procedures.
If you are allergic to any anaesthetics, please inform
your aesthetic practitioner about this on the health
form.
Bruising
Bruising may occur for lip procedures and anti-wrinkle in some cases prolonged bruising lasting 1 week to 10
days.
Allergic reaction
Avoid any lipstick or other lip products to reduce the risk of any infection immediately after the procedure
Cold Sores lip procedure
If you are prone to cold sores or fever blisters there is a probability that a lip procedure will cause an outbreak. It is advised that you call your doctor for a prescription for an anti-viral to help prevent this from
occurring
Necrosis
The risk of injecting into a blood vessel may occur resulting in tissue damage.
This can be resolved if immediate action is taken to minimise damage.
Eyelid, lip, or brow drooping
Ptosis has been found to occur in approximately 5% of patients who receive anti-Wrinkle injections and can occur up to two weeks after receiving the injections.
Health Form
Please read carefully below and advice the aesthetic practitioner if any of the following apply, if answered yes to any questions on Section A this may constitute as a contraindication and a doctor’s consent form may be requested. Ensure you are satisfied with the explanations and information given regarding your assessment / treatment and that you understand that it is your right and responsibility to ask further questions if anything is unclear. You can ask for a chaperone or discontinue of proceeding at any time. By signing you confirm that you have been given sufficient information to understand your treatment and the products used including contra indications and adverse effects as well as ‘of licence’ usage. And that you consent to us keeping a copy of the document on paper / computer and that you have read and understood the information / risks and what to expect. I am aged 18 and over:
