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Dysport® Consent Form Mobile App

Dysport is a trade name for Botulinum Purified Neurotoxin used to treat facial expression lines. This Dysport Consent Form mobile app outlines the temporary side effects to the treatment and any risks involved. Also captures both patient and physician signatures to inform consent.

This app will assist in the discussion about Dysport treatment and the possibilities of an allergic reaction, temporary muscle weakness, excessive sweating, and/or bruising and swelling of facial muscles.

This inform consent form can be downloaded to an iPhone, iPad, or Android device. All information is securely saved in the GoCanvas Cloud and can be printed or emailed as a PDF if you need to share it with others.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Dysport® Consent Form Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

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    Dysport ® is a trade name for Botulinum Purified Neurotoxin used totreat facial expression lines.

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    Bruising or Swelling.

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    Headache.

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    Asymmetry.

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    Numbness.

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    The onset of Dysport® gradually begins in 3-4 days and may take two weeks to see the full effect.

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    Patients with a history of neurological disorders such as myasthenia gravis, muscular dystrophy, ...

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    I have been informed that the practice of medicine is not an exact science and that no guarnatees...

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    Patient Signature

  • Ico date

    Date

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    Physician/Provider Signature

  • Ico date

    Date

  • ...and More!

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