A consent form does not create consent. Consent comes from the conversation in which the client understands what will be done, what can go wrong and what the alternatives are. The form is the record of that conversation. A good dermal filler consent form makes the conversation easier to have and easier to prove.
This guide walks through the sections a filler consent form should cover. It is a starting point for clinics writing or reviewing their own forms, not legal or medical advice. Your medical director and a legal advisor in your country should approve the final version.
1. Client details and screening
Start with who the client is and whether filler is suitable today. Screening questions usually cover:
- Pregnancy or breastfeeding
- Allergies, including to local anaesthetics such as lidocaine
- Autoimmune conditions and medicines that affect the immune system
- Blood thinners and supplements that increase bruising
- Active skin infection, acne or cold sores near the treatment area
- Previous fillers in the same area, especially permanent or unknown products
- Recent or planned dental treatment, surgery or other procedures
- History of keloid or abnormal scarring
Keep the full medical history in the intake form and refer to it here, so the client confirms it is still correct on the day.
2. The treatment
Describe what will be done in plain words:
- The type of product, for example a hyaluronic acid dermal filler
- The areas to be treated
- The expected result and how long it typically lasts, with a note that duration varies by product, area and person
- That more than one session or a top-up may be needed
The treatment record, not the consent form, is where product name, lot number and volume per area belong. Many clinics keep these on a face chart so the next practitioner can see exactly what was used and where.
3. Common side effects
List the effects most clients will notice and how long they usually last:
- Swelling, redness and tenderness at injection points
- Bruising
- Small lumps or unevenness that often settle as swelling goes down
4. Rare but serious risks
This is the section that most often goes missing or gets softened. A clear consent form names the rare risks plainly:
- Infection
- Delayed swelling or nodules, which can appear weeks or months later
- Vascular occlusion, where filler blocks a blood vessel. It can cause skin damage and, very rarely, problems with vision, including blindness
- Allergic reactions
For hyaluronic acid fillers, it is good practice to explain that the filler can be dissolved with hyaluronidase if needed, and that the clinic has an emergency protocol.
5. Alternatives
Include the option of no treatment, and other approaches where they exist. Listing alternatives is part of informed consent and it reassures the client that they are not being sold one answer.
6. Aftercare
Summarise the key instructions and point to the full aftercare sheet. Typical points include avoiding strenuous exercise, heat and alcohol for the first day, not pressing or massaging the area unless told to, and who to call if pain, colour change or swelling gets worse instead of better. Make the “call us right away” signs impossible to miss.
7. Photos and marketing
Ask separately whether clinical photos can be used for records only, or also for marketing. Keep it as its own tick box with its own signature, so a client can say yes to records and no to social media.
8. Signatures
- Client name, signature and date
- Practitioner name, qualification and signature
- A line confirming the client had the chance to ask questions and received a copy
Make the process match the form
Give clients the form to read before the appointment, not on a clipboard two minutes before treatment. Many practitioners leave time between consultation and treatment so the client can think it over. Keep the signed form with the treatment record and photos.
Templates
Our Aesthetic Clinic Kit includes 12 consent forms from A to L, covering anti-wrinkle injections, dermal fillers, skin boosters, microneedling, chemical peels, PRP, laser and IPL, biostimulators, PDO threads, polynucleotides, fat-dissolving injections and photo consent. Each comes as an editable page in the kit builder and as a Word file, alongside a client intake form and a treatment record with a face chart and lot log.