I,  {name} (Patient) understand and agree to undergo dermal filler treatment at Prestige Health / (Happy & Relaxed) under the care of Elisa C. Alvarado MD. I have been provided with the following information regarding the procedure:

1. Purpose of Treatment:
Dermal fillers are injectable substances used to restore volume and enhance facial features. The purpose of this treatment is to address specific concerns such as wrinkles, fine lines, and loss of facial volume.

2. Procedure Description:
The procedure involves the injection of dermal fillers into the targeted areas of the face. The specific areas to be treated have been discussed and agreed upon with the healthcare provider. The treatment may involve multiple injections and can take approximately 30/45 minutes to complete.

3. Risks and Side Effects:
I understand that, like any medical procedure, there are potential risks and side effects associated with dermal filler treatment. These may include but are not limited to:

Redness, swelling, or bruising at the injection site
Allergic reactions
Infection
Discomfort or pain during or after the procedure
Lumpiness or unevenness in treated areas
Skin discoloration
Rare complications such as vascular occlusion or embolism

4. Expected Results:

I understand that the results of dermal filler treatment vary from person to person. While the healthcare provider will strive to achieve the desired outcome, there is no guarantee of specific results. The duration of the effects will also depend on various factors, including the type of filler used.

5. Alternative Options:
I have been informed of alternative treatment options for addressing my concerns, including but not limited to other non-invasive procedures or surgical interventions. I have chosen dermal fillers after considering these alternatives.

6. Aftercare Instructions:
I understand that it is important to follow the aftercare instructions provided by the healthcare provider to optimize the results and minimize the risk of complications. These instructions may include avoiding excessive heat or sun exposure, refraining from touching or massaging the treated areas, and using recommended skincare products.

7. Financial Responsibility:
I understand that the cost of the dermal filler treatment is my responsibility. The healthcare provider or the clinic will provide me with the details of the fees, payment options, and any cancellation policies.

8. Confidentiality: I understand that my personal and medical information will be kept confidential in accordance with applicable laws and regulations. I have had the opportunity to ask questions and have received satisfactory answers regarding the dermal filler treatment. I consent to the procedure and acknowledge that no guarantees or assurances have been made regarding the results or outcome.