Skin booster consent form template (UK)

This template is for UK aesthetics practitioners offering injectable skin boosters, the category of hydrating microinjection treatments that includes classic hyaluronic acid boosters and products such as Profhilo. Because “skin booster” covers many different products, the consent risk in this category is vagueness: a form that says “skin booster treatment” without naming the product, the protocol or the specific risks is hard to defend. A defensible consent form is informed, specific to the product and areas treated, signed by patient and practitioner, versioned and retrievable on request.

Why each section exists

The product and batch fields are the backbone of this form. A skin booster menu can include several products with different compositions, protocols and risk profiles, so the consent must name what is actually being injected, and the batch number is what makes a manufacturer recall manageable. Check the manufacturer’s guidance for the specific product you use and adapt the treatment information paragraph to match its protocol.

The course structure section manages the most common dissatisfaction in this category. Skin boosters work gradually across a course, and a patient who expects a filler-style immediate change, or who stops after one session, will judge the treatment a failure. A signed acknowledgement that results are gradual and course-based settles that conversation before it starts.

England’s planned licensing scheme for non-surgical cosmetic procedures signals that written consent and complete treatment records will become baseline requirements across the sector. Insurers already expect itemised risk disclosure and evidence of screening; this template gives you both.

The template

Patient details

Full name: ___________________________

Date of birth: ___________________________

Phone: ___________________________

Email: ___________________________

Address: ___________________________

Treatment details

Product (brand and presentation): ___________________________

Batch number: ___________________________ Expiry: ___________________________

Area(s) to be treated: ___________________________

Session number and total sessions planned in this course: ___________________________

Planned interval between sessions: ___________________________

Date of treatment: ___________________________

About this treatment

Skin boosters are microinjections of hydrating products, most commonly based on hyaluronic acid, placed superficially in the skin to improve hydration, glow, texture and overall skin quality. They do not add volume or alter the shape of facial features. Treatment is usually given as a course of sessions spaced several weeks apart, with maintenance sessions thereafter, and results develop gradually. No specific outcome can be guaranteed.

Contraindications and screening

Please confirm each of the following:

• I am not pregnant and not breastfeeding
• I do not have an active skin infection, cold sore, acne flare or broken skin in the treatment area
• I do not have a known allergy to any component of the product or to local anaesthetics used during treatment
• I do not have a bleeding disorder and have disclosed any blood-thinning medication or supplements
• I have disclosed any autoimmune condition, immunosuppressive treatment or significant medical history
• I have disclosed all previous aesthetic treatments in the area, including filler, and any complications
• I have disclosed any recent or planned dental work, vaccination or other medical procedure my practitioner has asked about

Risk acknowledgement

I understand and accept the following recognised risks of skin booster treatment:

• Injection-site reactions including redness, tenderness and warmth, usually settling within a few days
• Small bumps at the injection points, usually settling within 24 to 48 hours
• Bruising at some injection points, which can take a week or more to fade
• Swelling of the treated area
• Infection at the injection sites
• Allergic reaction to the product or to anaesthetic used during treatment
• Rare vascular events, where product affects a blood vessel; these are uncommon and your practitioner will explain the warning signs, which need urgent assessment

Aftercare commitment

• I agree to follow the written aftercare instructions, including avoiding makeup until the injection points have closed, avoiding alcohol, strenuous exercise and heat for 24 to 48 hours, avoiding facials and similar treatments over the area for the advised period, and using high-factor sun protection daily.

Photography

• I consent to clinical photographs being taken before and after treatment for my confidential patient record.
• I additionally consent to my photographs being used for marketing purposes (optional).

Outcome

• I understand that results develop gradually over a course of treatment, vary between individuals, and cannot be guaranteed, and that stopping a course partway through means an incomplete treatment.

Patient declaration

I confirm that I have read and understood the information above, that I have had the opportunity to ask questions and that they have been answered to my satisfaction. The information I have given is true and complete. I consent to skin booster treatment as described.

Patient signature: ___________________________

Print name: ___________________________

Date: ___________________________

Practitioner declaration

I confirm that I have explained this procedure to the patient, including its intended benefits and material risks, and any available alternative treatments, and that the patient has had the opportunity to ask questions.

Practitioner signature: ___________________________

Print name and qualification: ___________________________

Date: ___________________________

Using it in practice

Copy the template onto your own letterhead, name the product you actually use, and date the version so every signature can be matched to its exact wording. If you carry several skin booster products, keep a named, versioned form per product rather than one generic version. Complete the batch and expiry fields at the time of treatment, not afterwards, and record the session number so each visit in a course is individually documented. For the category background to use in consultation, see our skin boosters guide.

AesthetiClinic takes the admin out of this entirely: the consent form goes e-signed to the patient’s phone before the appointment, wording changes are versioned automatically, and the signed document files itself on the patient record. All the free documents live in the template library.

This template is provided as a starting point for UK aesthetics practice. It is not legal or medical advice. Review the wording with your insurer and, where relevant, your prescriber before use.