This professionally designed dermal filler intake form helps aesthetic providers gather key health information before performing hyaluronic acid or biostimulatory filler treatments. It includes fields for previous filler experience, complications, history of allergies or anaphylaxis, medication and supplement use, and medical conditions like herpes, autoimmune disease, or immunosuppression. The form supports patient safety, informed decision-making, and proper clinical documentation.

Download now to streamline your injectable consults with a compliant, easy-to-use dermal filler medical history form.