formisoft
Cosmetic Procedure Consent Form
Consent

Cosmetic Procedure Consent Form

3 pages•15 fields•HIPAA-ready
Get startedBrowse all templates

Form preview

formisoft.com/f/cosmetic-procedure-consent
Cosmetic Procedure Consent Form
Patient Full Name
Date of Birth
Procedure Name
Treatment Area
Expected Outcomes
Known Risks and Complications
Pre-Procedure Photos Authorized
Post-Procedure Care Instructions Reviewed
No Guarantee of Results Acknowledged
Allergies or Sensitivities
Patient Signature
Sign here
Date of Consent
Submit
Use this template

The Cosmetic Procedure Consent Form is designed specifically for medical aesthetics practices, dermatology clinics, and plastic surgery offices that perform elective cosmetic treatments. It addresses the unique informed consent considerations that arise when patients pursue procedures for aesthetic rather than medically necessary reasons.

This template covers procedure-specific details including expected outcomes versus guaranteed results, potential complications such as scarring or asymmetry, recovery timelines, and post-procedure care instructions. It includes important disclosures about the elective nature of the procedure and the possibility that additional treatments may be needed to achieve desired results.

Whether used for injectables like Botox and dermal fillers, laser treatments, chemical peels, or minor surgical procedures, this form helps cosmetic practices protect both patients and providers by ensuring thorough documentation of informed consent before any aesthetic intervention.

What's included

  • Patient demographics and contact information
  • Detailed procedure description and treatment area
  • Expected outcomes and limitations disclosure
  • Risk and complication acknowledgment
  • Pre- and post-procedure photo authorization
  • Post-procedure care instruction confirmation
  • Allergy documentation with severity levels
  • E-signature capture

Who uses this template

  • Documenting consent before Botox, filler, or injectable treatments
  • Obtaining informed consent for laser skin resurfacing or chemical peels
  • Recording patient acknowledgment for elective cosmetic surgery
  • Ensuring patients understand potential outcomes and limitations of aesthetic procedures

All form fields

12 fields across 3 pages. Customize any field after signing up.

Patient Full NameText
Date of BirthDate
Procedure NameText
Treatment AreaText
Expected OutcomesLong Text
Known Risks and ComplicationsLong Text
Pre-Procedure Photos AuthorizedMultiple Choice
Post-Procedure Care Instructions ReviewedCheckbox
No Guarantee of Results AcknowledgedCheckbox
Allergies or SensitivitiesAllergies
Patient SignatureE-Signature
Date of ConsentDate

Use this template

Sign up and start customizing the Cosmetic Procedure Consent Form for your practice. 30-day money-back guarantee.

Get startedBrowse all templates

$79.99/mo · Cancel anytime · HIPAA compliant

Related templates

Patient Full Name
Date of Birth
Tattoo Location & Size
Ink Colors Present
Fitzpatrick Skin Type
Consent

Tattoo Removal Consent Form

Tattoo removal consent form for laser tattoo removal clinics and dermatology practices. Covers treatment area documentation, skin type assessment, photo authorization, risks acknowledgment, payment collection, and informed consent for laser procedures.

2 pages•12 fields
Dermatology Intake Form
Patient Information
Primary Skin Concern
Duration of Concern
Sun Exposure History
Skin Cancer Risk Factors
Intake

Dermatology Intake Form

Dermatology-specific intake with skin concern history, sun exposure assessment, skin cancer screening questions, cosmetic treatment history, and photo upload for lesion documentation.

2 pages•14 fields
Anesthesia Consent Form
Patient Information
Anesthesia Type Explanation
Anesthesia Risk Acknowledgment
Previous Anesthesia Reactions
Malignant Hyperthermia History
Consent

Anesthesia Consent Form

Dedicated anesthesia consent covering anesthesia type options, risk acknowledgment, fasting instructions, and pre-anesthesia health screening. For anesthesiology departments and surgical centers.

2 pages•8 fields