Med spa consent forma starting point for your provider
Aesthetic medical treatments need informed consent from a licensed provider, under the supervision your state requires. This template covers the general part — reactions, contraindications, aftercare. Product-specific consents remain your medical director’s job.
Aesthetic treatment consent
The same wording clients sign in Luvira. Copy it and adapt it to your services and your state.
Aesthetic treatment consent
Aesthetic medical treatments (such as hyaluronic acid fillers, neurotoxin injections, threads or device-based procedures) involve treating the skin or the tissue beneath it. They are performed by a licensed provider, under the medical supervision your state requires.
Possible reactions: swelling, bruising, tenderness, redness and headache. Less common: asymmetry, lumps, infection, allergic reactions and temporary weakness of nearby muscles. Very rare but serious: blocked blood vessels with tissue damage, and vision problems.
We do not treat during pregnancy or breastfeeding, with an active infection in the treatment area, with certain neuromuscular conditions, or with a known sensitivity to the products used.
Aftercare: for several hours, no massaging the area, no exercise, sauna, tanning beds or lying face down; avoid alcohol and blood-thinning medication where your provider advises. Final results can take from a few days up to two weeks to show.
Please contact us if anything feels unusual after your treatment — strong pain, lasting redness, swelling or signs of infection. The sooner we know, the easier it is to help.
We cannot guarantee a specific result: skin, hair and healing differ from person to person. We work to the best of our professional knowledge and have explained the procedure, risks and alternatives to you. You had the opportunity to ask questions, and your questions were answered.
Questions to add to your intake form
Are you pregnant, trying to become pregnant or breastfeeding?
Do you have a neuromuscular condition or an autoimmune disease?
Do you take blood thinners, aspirin or supplements that affect bleeding?
Have you had fillers, neurotoxin or threads before — when, and where on the face?
Have you ever had a reaction to lidocaine or another anesthetic?
Do you have a dental appointment or vaccination planned in the next two weeks?
What this template is — and is not
This is a general aesthetic treatment consent. It names common reactions such as swelling and bruising, less common ones, and the rare but serious risks such as blocked blood vessels and vision problems. It is not a substitute for product-specific consent, which your provider explains in person.
Who may perform which treatment, and under whose supervision, is set by each state. The consent does not answer that; your medical director does.
Records and privacy
Whether HIPAA applies to your practice depends on how you operate — for example whether you bill health insurance. Luvira makes no HIPAA claim and is not an electronic health record. Keep clinical charting where your practice keeps it today.
Not legal or medical advice. Aesthetic medical treatments are regulated by each state; have this template reviewed by your medical director and attorney.
More for med spas
Other specialties
Frequently asked questions
About consent forms for med spas
No. It covers general aesthetic treatment risks. Product- and procedure-specific consent, and the conversation with the provider, still belong to your medical process.
No. Luvira makes no HIPAA claim and does not sign business associate agreements. Practices that are covered entities should keep protected health information in a system built for that.
Not yet — the wording is fixed in Luvira and stored with a version number on every signature. If your director requires different wording, keep using your own form for those treatments.
Many providers ask so they can plan treatment timing around them. Your provider decides how to use the answer.
Still have questions?
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