Templates
AESTH-01
AESTH-01Botox / Filler

Injectable Procedure Consent & Record

Aesthetic & Cosmetic សោភ័ណភាព និង ការកែសម្ផស្ស

BS DERMA
Clinic Management System
⚠️ INFORMED CONSENT FOR INJECTABLE PROCEDURES / ការយល់ព្រមដឹងហើយសម្រាប់វិធីសាស្ត្រចាក់
⚠️CONTRAINDICATIONS: Pregnancy, breastfeeding, neuromuscular disorders (for Botox), active infection, allergy to product components, keloid tendency, anticoagulant use.
Procedure DescriptionThis procedure involves injecting substances into specific facial areas to reduce wrinkles, restore volume, or improve skin quality. Effects are temporary and may require repeated treatments.
Risks & Side EffectsPain, bruising, swelling, redness, asymmetry, infection, allergic reaction, vascular occlusion (filler), ptosis (Botox), unsatisfactory results.

Patient Consent

Photography Consent

Product Information / ព័ត៌មានផលិតផល

Zone / តំបន់Product / ផលិតផលVolume (mL)Depth / ជម្រៅTechnique / វិធីSide Effects
Treating Physician
វេជ្ជបណ្ឌិតព្យាបាល
Signature
Patient
អ្នកជំងឺ
Signature
Witness
សាក្សី
Signature
BS Derma Clinic | Injectable Procedure Record | Template: AESTH-01 v2.0