Form Aesthetica

Medical, Consultation & Informed Consent Form

1. Patient Details

First Name

Last name

Date of Birth

Day

Month

Year

Contact Number

Email

2. Patient Consent & Introduction

I understand that medical aesthetic treatments are elective, non-surgical procedures and results vary. Treatments may include injectables, skin boosters, neuromodulators, biostimulators, regenerative therapies, and other medical aesthetic procedures.

I understand that expected effects may be immediate or gradual and may include temporary swelling, redness, bruising, or discomfort. A settling period of up to 2–4 weeks may be required. Results are temporary and maintenance treatments may be needed.

I understand that risks may include infection, uneven results, delayed reactions, or rare but serious complications. I confirm that I have disclosed my full medical history and consent to treatment.

I confirm that I have read and understood the above and agree to proceed.

3. Medical History

Do you have any past medical history?

No

Yes

Are you currently under medical investigation or awaiting a diagnosis?

No

Yes

Do you take any regular medication?

No

Yes

Do you have any allergies (including medication, food, latex)?

No

Yes

4. Pregnancy & Breastfeeding

Are you currently pregnant or breastfeeding?

Yes

No

5. Aesthetic & Cosmetic History

Have you had any aesthetic or cosmetic treatments before?

No

Yes

Have you experienced any complications from previous treatments?

No

Yes

6. Treatment Understanding

Do you understand which treatment you are receiving today?

No

Yes

7. Expected Results & Aftercare

I understand that results are temporary. Swelling, bruising, and discomfort are common and may last 2–4 weeks, or longer depending on individual lifestyle, stress levels, and consumption habits.

I understand and accept the above.

8. Risks & Complications

I acknowledge that aesthetic treatments carry risks, including rare but serious complications, and that emergency treatment may be required in exceptional cases.

I understand and accept the risks involved.

9. Photography Consent (Medical Records)

I consent to clinical photographs/videos being taken for confidential medical records only.

Yes

No

10. Marketing & Media Consent

I consent to before-and-after photos/videos being used for marketing, education, and social media.

Yes, I consent.

No, I do not consent.

Please review Terms & Conditions if you consent.

We love when our clients choose to share their FORM experience. As a thank-you, we offer optional incentives for clients who voluntarily share their results on social media, subject to the terms below.

Incentive Options (Please tick if interested - Aesthetics Only)

£30 Off Your Next Visit. If you share a partial / half-face image or video.

£60 Off Your Next Visit. If you share a full-face Before & After image or video showing visible results.

Not interested.

Would you also like to receive more information about FORM’s content creator incentives or collaboration opportunities?

Yes, please contact me.

No, not at this time.

11. Final Declaration & Consent

I confirm that I have had sufficient time to consider my decision.

All my questions have been answered to my satisfaction.

Signature

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Date