Consent form

Skin booster and Profhilo consent form template (UK)

A skin booster consent form should name the exact product and presentation, record the treatment areas and link the information discussed with the patient. Use product-specific risks, alternatives and aftercare approved by a qualified practitioner. Profhilo is a brand with different product presentations, so one generic skin booster form is not enough without adaptation.

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Version 2026-10-11. Adapt it for your clinic before use. Read the full HTML document.

Written by Connor McAuley

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Audience
Qualified aesthetic practitioners
Available now
Full HTML and a copyable text version, plus PDF and Word downloads
Scope
england, scotland, wales, northern ireland
Before use
Documentation structure only; clinic-specific wording requires qualified review before use. Version 2026-10-11.

For qualified practitioners: a template to adapt, not clinical advice.

Use your clinical judgement for every patient. Check the products you use, your protocols, manufacturer instructions, your prescriber's directions where relevant, and your insurer's requirements.

The template

[Clinic name] product-specific skin booster consent record

Form version: [date]

The practitioner must complete the product information, material risks and alternatives before the patient reviews this document. Use additional pages if needed and identify each one by version.

Patient and appointment

Full name: ___________________________

Date of birth / patient record reference: ___________________________

Appointment date: ___________________________

Practitioner name and professional registration, where applicable: ___________________________

Medical history reviewed on: ___________________________

Exact treatment proposed

Product brand and full presentation: ___________________________

Manufacturer: ___________________________

Area(s) proposed: ___________________________

Treatment purpose and intended benefit discussed: ___________________________

Planned sessions, intervals and review arrangements, if applicable: ___________________________

Fees and any course or maintenance terms discussed: ___________________________

Product instructions for use: title / version / date checked: ___________________________

Patient information supplied: title / version / date: ___________________________

Product-specific information and alternatives

Plain-language explanation approved by the clinical reviewer: ___________________________

Expected course of response and limits of the proposed treatment: ___________________________

Alternatives discussed, including choosing no treatment: ___________________________

Reasons for the patient’s preference and expectations discussed: ___________________________

Assessment and individual risks

Linked suitability assessment and decision reference: ___________________________

Relevant history, medicines, allergies or previous treatment discussed: ___________________________

Material risk explained for this product and area Patient-specific relevance / discussion Information document reference

Any uncertainty, limits of knowledge or additional information discussed: ___________________________

Questions asked by the patient and answers given: ___________________________

Aftercare and contact arrangements

Clinician-approved aftercare document: title and version: ___________________________

How and when it was supplied: ___________________________

Warning signs and escalation information discussed, as specified in the approved information: ___________________________

Clinic and out-of-hours contact details supplied: ___________________________

Follow-up arrangement: ___________________________

Clinical photographs

Clinical photographs proposed and purpose explained: ___________________________

Patient’s decision and confidential-record reference: ___________________________

Any optional marketing-image permission must be obtained separately. Refusing marketing use does not change the treatment decision.

Patient decision

  • The exact product, treatment areas and intended benefit have been explained to me.
  • I have discussed relevant risks and alternatives, including having no treatment.
  • I have had the opportunity to ask questions and have received answers I understand.
  • I understand the limits of the expected outcome and that no specific result is guaranteed.
  • I have been given the agreed information and know how to contact the clinic.

My decision: Proceed with the treatment described / Do not proceed / More time or information needed

Patient name and signature: ___________________________

Date and time: ___________________________

Interpreter, support or accessibility arrangements, if applicable: ___________________________

Practitioner confirmation

I have recorded the product-specific discussion and the patient’s decision, including relevant individual risks, alternatives and questions. I have confirmed the decision with the patient before any treatment proceeds.

Practitioner name, signature and date/time: ___________________________

Clinical reviewer of this form’s wording: name, role and approval date: ___________________________

Actual product / presentation used: ___________________________

Batch / lot and expiry: ___________________________

Amount used, date and treatment record / face chart reference: ___________________________

Change from the proposed treatment and renewed discussion, if applicable: ___________________________

Product traceability / implant card reference, where applicable: ___________________________

I build the software that keeps a consent form with the patient’s record. The document still needs to show which product was discussed and what the patient agreed to, even when the clinic offers several treatments under one menu heading.

Name the product before using the form

This is a consent recording framework for qualified practitioners. Complete the product information and risk fields before presenting it to a patient; blank placeholders are not treatment information.

The GMC’s consent guidance describes consent as an exchange of information that supports a patient’s decision. A signed template records part of that process; it does not replace the conversation or guarantee legally valid consent.

Profhilo is part of IBSA’s product range. The manufacturer’s instructions library lists separate leaflets for Profhilo, Profhilo Body and Profhilo Structura. Record the full presentation rather than using the brand name alone, and have your reviewer check the leaflet supplied with the product used in your jurisdiction.

IBSA’s English Profhilo leaflet, accessed through that library, includes product traceability and implant-card information. Keep the relevant reference with the treatment record. We do not reproduce injection points, dose, session intervals or product-specific risk wording here.

The name Profhilo in this template does not imply manufacturer approval, a universal consent form or interchangeability between presentations. If you change product or presentation, review the information, risks and record links before using the wording again.

Keep the signed wording with the record

Keep the completed consent and the exact patient-information version together. A product batch can be added to the linked treatment record when the actual product is used; the information discussed beforehand should identify what was proposed.

The GMC record guidance supports recording decisions and information shared with patients. Pair this framework with the medical history form and face chart, and retain the full treatment record.

FAQ

Use a common structure if helpful, but complete the product-specific information and have it reviewed. A category name does not identify the ingredients, intended use, risks or presentation discussed.

It is a framework to adapt. A qualified practitioner must complete and approve the wording for the actual presentation and patient discussion before use.

A signature records agreement at a point in time. The information, questions, individual circumstances and decision also need to be documented. A signature cannot supply a discussion that never happened.

Where should marketing-photo permission go?

Use a separate optional permission process. The treatment consent and confidential clinical-photograph record should not require the patient to agree to advertising use.

Your next step

Read and copy the framework or use the available download, then ask your clinical reviewer to approve a product-specific master. The consent software page shows the related record workflow. This is a documentation starting point, not medical or legal advice.

Before you use it

Adapt it for your clinic.

  • Use your own details.

    Name your clinic and the products and services you actually provide. Replace every placeholder before use.

  • Review the wording.

    Check the final form against your protocols, your prescriber's directions where relevant, and your insurer's requirements.

  • Keep the version.

    Date the final document and keep the exact wording used. Review it when your services, products or terms change.

Send forms to the patient's phone, capture an e-signature and keep the signed record.

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Copy this template for your clinic.

Copy the full text into your own document and adapt it. Check the final wording with your insurer.

This action copies text.

Optional clinic-owner notes

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Sources and corrections

Something needs correcting? Email hello@aestheticlinic.io. How we check what we publish.

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