Cosmetic Procedure Consent Form
Patient Information
Full Name
Date of Birth
Phone Number
Email
Procedure Details
Procedure Name
Date of Procedure
Practitioner's Name
Health Information
Relevant Medical History
Current Medications
Allergies
Consent and Acknowledgements
I have had the procedure explained to me and understand the risks and benefits.
I have had the opportunity to ask questions and have received satisfactory answers.
I understand the possible side effects and complications.
I consent voluntarily to the procedure described above.
Patient Signature
Date
Practitioner Signature
Date