This focused informed consent form is designed specifically for dermal filler injections involving lidocaine-based formulations (e.g., Juvederm®, Restylane®). It confirms the patient’s absence of hypersensitivity to anesthetics, such as novocaine, and addresses rare risks like malignant hyperthermia. Created for licensed aesthetic providers, this form documents medical clearance and supports legal protection prior to administering local anesthetic-enhanced fillers.

Download now to safeguard your clinic and standardize documentation for all lidocaine-containing injectable filler treatments.