Consent Form for Lip Filler Treatment

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Acknowledgment of Treatment

Procedure Explanation:
- The lip filler procedure involves the injection of dermal fillers to enhance lip volume, shape, and symmetry.
Risks & Side Effects:
- Possible risks include swelling, redness, bruising, pain, allergic reactions, and rare complications such as infection or vascular occlusion.
- Results may vary, and the duration of the filler can last 3-12 months depending on the product and individual metabolism.
Pre- & Post-Treatment Care:
- Avoid alcohol, blood-thinning medications, and intense heat (e.g., saunas) 24-48 hours before and after the procedure.
- Follow all aftercare instructions provided by your technician to minimize side effects and ensure optimal results.
Temporary Nature of Results:
- I understand that lip fillers are temporary and require maintenance treatments for desired results.
No Guarantee of Results:
- While every effort is made to achieve desired outcomes, results cannot be guaranteed.
Health Disclosure:
- I have disclosed all relevant health conditions, allergies, and medications to my technician.
- I am not pregnant or breastfeeding.
Consent to Treatment

By signing this document:

1. Voluntary Consent to Treatment:
- I voluntarily consent to the lip filler procedure performed by Heavenly Aesthetics Miami, and I acknowledge that I am receiving this treatment at my own request.
2. Release of Liability:
- I understand and agree that Heavenly Aesthetics Miami, its technicians, employees, and representatives are not liable for any adverse effects, complications, or unsatisfactory results that may arise from this procedure, except in cases of gross negligence or willful misconduct.
- I waive my right to pursue any legal claims against Heavenly Aesthetics Miami related to the procedure, understanding that this release is binding and enforceable to the fullest extent permitted by law.
3. Understanding of Documentation:
- I confirm that I understand this consent form in its entirety, whether in English or Spanish.
- If I require assistance in understanding this form, I have been provided with a translation or legal explanation and fully comprehend the terms outlined herein.
- I affirm that I have had the opportunity to ask any questions regarding the form and the procedure and that all my questions have been answered to my satisfaction.
4. Acknowledgment of Responsibility:
- I acknowledge that I am responsible for following all pre- and post-treatment care instructions provided to me.
- I accept that failure to adhere to these instructions may affect the outcome of the procedure, and I will not hold Heavenly Aesthetics Miami responsible for any resulting issues.
Client Statement:

I certify that:
- I am of legal age and mentally competent to make decisions regarding my health and beauty treatments.
- I have reviewed and fully understand this consent form, and I agree to its terms freely and without coercion.
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Acknowledgment of Treatment