This detailed pre-treatment questionnaire is designed to assess patient suitability for neuromodulator injections, such as Botox®, Dysport®, Xeomin®, or Jeuveau®. Created for licensed aesthetic providers, it screens for contraindications including neuromuscular disorders, medication interactions, bleeding risks, and facial asymmetries, while also documenting physical findings and treatment concerns. Includes patient and provider signature fields for proper documentation and informed decision-making.

Download now to protect your patients and practice with a professional, comprehensive pre-injection screening tool for safe and effective wrinkle relaxer treatments.