BOTOX® Patient Consent FormBOTOX® Patient Consent FormBOTOX® Patient Consent Form
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INFORMED CONSENT – BOTULINA TOXINS - BOTOX® INJECTION
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©2009 American Society of Plastic Surgeons . Purchasers of the Patient Consultation Resource Book are given a
limited license to modify documents contained herein and reproduce the modified version for use in the Purchaser's
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own practice only. All other rights are reserved by American Society of Plastic Surgeons . Purchasers may not sell
or allow any other party to use any version of the Patient Consultation Resource Book, any of the documents
contained herein or any modified version of such documents.

INFORMED CONSENT – BOTULINA TOXINS - BOTOX® INJECTION
INSTRUCTIONS
This is an informed-consent document which has been prepared to help your plastic surgeon inform you concerning
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BOTOX (Botulina Toxin Type A, Allergan) injection, its risks, and alternative treatments.
It is important that you read this information carefully and completely. Please initial each page, indicating that you
have read the page and sign the consent f