Dermal Filler Consent Form

About this form

The dermal filler consent form is a consent forms document used by med spa practices. Informed consent for hyaluronic-acid dermal filler injections including risks, downtime, and aftercare. In BoomCloud Forms it is a starting point: every field, heading and statement can be edited before you share it with patients.

Practices may use this template as a starting point and should review the wording against their own professional, regulatory and legal requirements before use.

What's included

This template ships with 10 fields:

• Client Name — Text
• Date of Birth — Date
• Product / Brand — Text
• Treatment Area(s) — Text
• I have read and understood the risks — Single choice
• I have received post-care instructions — Single choice
• Questions discussed with the provider — Long answer
• Signature — Signature
• Date — Date

When practices use it

Med Spa teams typically attach this form to the treatment workflow, completing it with the patient after the procedure and its alternatives have been discussed. It can be sent digitally ahead of the visit, completed on a tablet in the office, or printed as a PDF.

How to customize it

• Reword any question, add fields, or remove ones your practice doesn't need.
• Apply your practice name, logo and colors so the form matches your brand.
• Switch to another supported language where a translated version exists.
• Share a secure link with the patient, or download a print-ready PDF.