Templates / Cytocare consent form

Aesthetics & Beauty

Cytocare consent form

Free PDF • 3 pages, print-ready • Clinician-reviewed

Anja Dodevska Last updated October 27, 2026 Reviewed by Dr. Vanja Kitanova

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Cytocare is a hyaluronic acid-based mesotherapy skin booster from Revitacare, injected into the superficial dermis to improve hydration and elasticity and soften fine lines. This free Cytocare consent form gives your practice one structured record of screening, consent and aftercare for every session.

The form explains the treatment, its contraindications, possible side effects and aftercare in plain language. The patient then answers consent and medical history questions and signs.

It suits med spas, aesthetic practices and dermatology practices that offer Cytocare on a skin quality menu. Check each field against the current manufacturer instructions for use (IFU) before you adopt it.

Template details

Template type

Consent form

Format

Printable PDF, 3 pages

Sections

1 section

Fields to complete

21 fields

Best for

Aesthetics & Beauty

Key takeaways

Cytocare is a hyaluronic acid mesotherapy skin booster made by Revitacare, injected for skin hydration and rejuvenation.

Screen medical history, pregnancy, allergies, infection and autoimmune conditions before every session, using the current manufacturer IFU.

This form covers the injectable Cytocare 502, 516, 532 and S Line products, not the topical C Line.

Record the product, batch number and aftercare advice given at each session of the course.

Pabau, our practice management platform, keeps the signed form, clinical photos and treatment notes on one patient record.

What is Cytocare used for?

Cytocare is used to improve skin hydration, elasticity and radiance, and to soften fine lines and wrinkles. Practitioners inject it into the superficial dermis of the face, neck, décolletage or hands over a course of sessions. Revitacare classes the injectable range as Class III medical devices intended for medical doctors.

Because Cytocare is an injectable, the clinical risk sits in patient selection and technique. Practices need a record showing the assessment was done, consent was taken and aftercare was explained. Volumizing filler work is a different treatment and needs its own dermal filler consent form.

How to fill out the consent and assessment form

Talk the patient through the treatment information first, then move to the screening questions, consent and sign-off. The form follows that order, so the record reads the way the consultation happened.

1. Go through the treatment overview, contraindications, possible side effects and aftercare advice with the patient.
2. Have the patient confirm the consent statements, including consent to clinical photos and videos.
3. Record the yes/no answers on understanding, sufficient information and freely given consent.
4. Complete the medical screening questions, from pregnancy and allergies to active infection and current medication.
5. Capture the free-text answers on medical history, treatment aims, previous treatments and concerns.
6. Note the product, batch number and treatment areas in the treatment record before the patient signs.

Which products the form covers

The injectable Cytocare range is sold as numbered formulas 502, 516 and 532, plus the S Line. Record the exact product and batch used in each session, because the formulas differ in their active complex.

Cytocare 640 and 715 belong to Revitacare’s separate C Line of sterile cosmetics. They are applied topically by massage, micro-current or plasmaporation and are never injected, so they fall outside this form’s scope.

Cytocare injection assessment and contraindications

Confirm suitability before any product is drawn up. Record the medical history, current medications, allergies and any previous reactions to skin treatments.

The form screens for pregnancy and breastfeeding, patients under 18, and known allergies to any component, including hyaluronic acid. It also asks about active skin infection at the treatment site, autoimmune and neuromuscular conditions, bleeding disorders and current antibiotics.

Confirm the absolute and relative contraindications listed in the current Revitacare IFU. Where a contraindication applies, record the reason and the decision taken. Do not rely on a summary when the IFU is the controlling document.

Following the injection protocol

Follow the manufacturer’s protocol for injection depth, technique, dose and session spacing. Record each of these in the treatment note alongside the signed form, so the treatment plan is clear to the next practitioner.

Injection depth and dosing must align with the Revitacare IFU. Where your practice protocol differs, document the rationale.

Aftercare advice to give and record

Give written aftercare advice at the end of each session. Record that the advice was given and that the patient had the chance to ask questions.

The form advises patients not to touch the area or apply makeup for at least 12 hours. It also tells them to avoid alcohol, strenuous exercise, sun exposure, steam rooms and saunas for 24 to 48 hours. For a standalone take-home sheet, pair it with our mesotherapy aftercare template.

• Record the aftercare advice given and the date.
• Note any reported side effects and the follow-up plan.
• Confirm the next session date where a course is planned.

Who benefits from one shared form

The template is most useful where several practitioners deliver Cytocare. One shared form means every injector screens the same contraindications and gives the same aftercare advice. A new team member also documents a course the same way as the rest of the practice.

A consistent record makes it easier to show that assessment, consent and aftercare happened. That matters when a patient later questions a result or a reaction.

Regulatory and data protection considerations

UK practices should check the product’s regulatory status with the MHRA and confirm the CE marking applies to the device as supplied. Cytocare is CE-marked in Europe but is not FDA-approved or cleared for use in the US.

Consent forms hold personal data, so UK and EU practices need to handle them under GDPR and the ICO’s guidance. In the US, a signed consent form kept in the patient record is protected health information under HIPAA.

Clinical photos taken under the form’s photo consent carry the same duty, and our guide to before and after photo consent covers the US requirements.

How Pabau keeps consent and treatment records together

Many practices still print a Cytocare consent form, have it signed at the front desk, then scan it into a separate folder. The batch number goes in one place, the treatment note in another, and the aftercare advice is often not recorded at all.

Pabau, the medical spa software we build, turns the form into a digital consent that patients complete before they arrive. Their answers, signature and clinical photos save straight to their client card, next to the treatment notes for each session.

The result is one complete record per course of treatment. When a patient asks about a reaction months later, your team can find the consent, product and advice in seconds.

Keep every Cytocare record in one place

Pabau stores digital consent, treatment notes and aftercare for each session, so your team can find the record in seconds.

Book a demo

Conclusion

Cytocare is usually given as a course, and each visit is a fresh injection with its own screening and aftercare. Problems tend to start with a screening question skipped on the third visit, or an aftercare conversation nobody wrote down.

Adopt one form for every Cytocare session, check it against the current IFU, and treat an unanswered screening question as a reason to pause. The few minutes it adds to each appointment make the record defensible if a result or reaction is ever questioned.

Book a demo to see how Pabau sends, signs and stores Cytocare consent forms alongside every treatment record.

Continue your research

Treating fat as well as skin quality? Aqualyx consent form covers screening and consent for injectable fat dissolving.

Using a Teoxane skin booster instead? Teoxane consent form gives you a ready-made consent record for the Teoxane range.

Need a patient handout for after the session? Skin booster aftercare sets out recovery tips patients can take home.

Comparing skin booster protocols? Profhilo injection protocol walks through the BAP technique point by point.

Offering collagen-stimulating injectables too? Sculptra consent form covers consent for poly-L-lactic acid treatments.

Frequently asked questions