• Please review the following information carefully and complete all required fields before treatment.

    NurseG LLC  | 📧 angelica@nurseg.net | 📸 @angiesinjectables
  • About the Treatment
    JUVÉDERM® ULTRA and ULTRA PLUS are hyaluronic acid (HA) dermal fillers used to smooth moderate to severe facial wrinkles and folds (such as nasolabial folds), restore volume to the lips, and enhance facial contours. JUVÉDERM® ULTRA PLUS provides more lift for deeper folds, while ULTRA is ideal for finer lines and lip augmentation. Results typically last 6–12 months or longer with maintenance treatments.

  • Risks and Complications
    Possible side effects include: temporary redness, swelling, pain/tenderness, bruising, firmness, lumps/bumps, discoloration, and itching at the injection site. Less common risks include infection, nodule formation, and asymmetry. Results are not guaranteed and may require touch-up treatments.

    Vascular Occlusion & Emergency Protocol
    A rare but serious risk of dermal filler injection is vascular occlusion — the unintentional injection of filler into or near a blood vessel, which may restrict blood flow to surrounding tissue. If left untreated, vascular occlusion can result in skin necrosis (tissue death), vision changes, or, in extremely rare cases, permanent vision loss or stroke.

    Warning signs include: immediate or delayed blanching (whitening) of the skin, severe or worsening pain beyond expected discomfort, mottled or bluish skin discoloration, and any changes in vision during or after the procedure.

    Emergency Reversal with Hylenex® (hyaluronidase): In the event of a suspected vascular occlusion, Nurse G LLC is prepared to administer Hylenex® (hyaluronidase), an FDA-approved enzyme that dissolves hyaluronic acid filler and helps restore blood flow to the affected area. Patient acknowledges that Hylenex® may be administered without additional consent if a vascular occlusion emergency is suspected, as time-sensitive intervention is critical. Patient also understands that Hylenex® use will dissolve some or all of the filler product previously injected.

    Patient agrees to seek immediate emergency medical care and to contact Nurse G LLC without delay if any of the above warning signs occur. Nurse G LLC and its providers are not liable for complications arising from failure to follow post-treatment instructions or failure to disclose pre-existing medical conditions prior to treatment.

  • Pregnancy / Allergies / Neurologic Conditions

  • Payment

  • Photo and Video Consent
    I authorize Nurse G LLC and its representatives to take clinical photographs and/or videos for documentation and marketing (social media and nurseg.net). These images may be used anonymously for educational or promotional purposes.

  • Post-Treatment Instructions
    After treatment:

    Avoid touching, rubbing, or applying pressure to the treated area for 24 hours.

    Avoid strenuous exercise, excessive heat, sun exposure, and alcohol for 24 hours.

    Avoid lying face-down for the first 4 hours.

    Apply ice gently to reduce swelling if needed.

    Avoid dental procedures or facial treatments for at least 2 weeks.

  • Results and Duration
    Results from JUVÉDERM® ULTRA/ULTRA PLUS filler treatment vary by individual and are influenced by treatment area, skin condition, metabolism, lifestyle, and the volume of product administered. Individual results are not guaranteed and may differ from those of others. Nurse G LLC and its providers make no warranties regarding the duration or outcome of treatment and are not responsible if effects wear off sooner than anticipated.

  • Acknowledgment and Consent
    I have read and fully understand this consent form. My questions have been answered to my satisfaction. I accept the potential risks and understand that results may vary.

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