Fillmed consent form template

Key takeaways

The free template on this page is a Fillmed consent and aftercare form, not a treatment record with product fields.

It covers the treatment disclaimer, seven contraindications, seven side effects and risks, six aftercare instructions, and a consent questionnaire.

Batch numbers, product names, injection sites, volumes and device settings belong in the patient’s clinical note, which this form does not hold.

MHRA recall handling and CQC inspection both rest on that batch-level detail, so record it at the point of use.

Pabau, practice management software for aesthetic practices, turns the form into a digital consent with e-signature and secure storage.

Fillmed products span injectable skin boosters, dermal fillers, medical-grade peels and mesotherapy. Each of those treatments needs consent that names the risks the patient is accepting. The form on this page gives you that document, ready to print.

One limit matters before you print it. The form carries no batch number, product or injection-site fields, so your clinical note still has to record those. Below you’ll find what the form contains, how to use it, and what to document alongside it for each Fillmed range.

What the consent form covers

The download is a three-page PDF written for the whole Fillmed range rather than one product. It’s a print-ready document, not an interactive form, so it has no fillable fields. Print it for the patient, or rebuild it inside your own digital consent workflow.

Page one speaks to the patient. Pages two and three carry the consent declaration and the screening questionnaire.

• Treatment disclaimer. A plain-English summary of the Fillmed range, from NCTF 135 HA skin boosters and Art Filler dermal fillers through to peels and mesotherapy.
• Contraindications. Seven statements telling the patient when treatment must not go ahead, covering pregnancy, allergy, active infection, autoimmune disease and age.
• Side effects and risks. Seven disclosures, from everyday bruising through to the rare risk of vascular occlusion needing urgent medical care.
• Aftercare advice. Six instructions on makeup, touching the area, alcohol and exercise, sun protection, and repeat procedures in the same area.
• Consent declaration. The wording the patient certifies, including consent for clinical photographs and videos and the non-refundable deposit clause.
• Medical history and consent questionnaire. 11 yes or no questions, then five free-text sections for history, aims, previous treatment, concerns and any further notes.

Contraindication screening on the Fillmed form

The form lists seven situations in which treatment must not proceed. Read them with the patient rather than handing the page over in silence.

• Pregnancy or breastfeeding
• Known allergy to hyaluronic acid, lidocaine or any component of the product
• Active skin infection, rash or open wound in the treatment area
• Autoimmune condition, uncontrolled diabetes, immunosuppressants or anticoagulants, unless a GP has cleared the patient
• A history of severe allergic reaction or anaphylaxis
• Recent laser, filler or peel work in the same area without adequate recovery
• Age under 18

The questionnaire asks about most of these again in yes or no form. That repetition earns its place. The patient reads the rule, then answers for themselves, and you have both on the page.

Side effects and risks the form discloses

The risk section is written to be read aloud at consultation. It covers the whole range, so injectable, peel and mesotherapy risks sit together.

• Redness, swelling or minor bruising at the treatment site, usually settling within 24 to 72 hours
• Temporary discomfort, tingling or tightness in the treated area
• A low risk of lumpiness or asymmetry after injectable treatment
• Mild flaking, sensitivity or temporary pigment change after mesotherapy or a peel
• A small risk of infection or allergic reaction
• A rare but serious risk of vascular occlusion after filler, needing immediate medical care
• Dissatisfaction with the outcome, and the chance that a course of sessions is needed

Documented expectation-setting about outcomes is the first item an insurer or a complaint handler asks to see.

Aftercare advice included in the form

The aftercare section is written for the patient to take home. It applies across the Fillmed range rather than to a single product.

• No makeup or heavy skincare for at least 12 to 24 hours
• No touching, rubbing or massaging the treated area unless you say otherwise
• No alcohol, strenuous exercise, sauna, steam room or sunbed for 24 to 48 hours
• Broad-spectrum SPF 30 or higher every day
• No other cosmetic procedure in the same area for 7 to 14 days
• Contact the practitioner if a side effect is unexpected or drags on

Give the patient a copy and note in the record that you did. Aftercare the patient denies receiving is hard to defend later.

What the form does not capture

The form handles consent. It doesn’t record the treatment itself, so a second document has to do that job.

• Product name and batch or lot number. There is no field for the syringe, vial or device you used, and no expiry date box.
• Volume and injection sites. The form has no body diagram and no space for milliliters placed per site.
• Needle or cannula detail. Gauge, cannula size and injection depth are absent, as are Nanosoft device settings.
• Signature and date lines. The consent wording is printed, but the page carries no signature, name or date field.
• Follow-up date. There is no review-appointment box, so book and record the review in your diary system.
• Before and after photographs. The form takes consent for clinical images, and the images themselves live in the patient record.

Add a signature and date line before you print, or capture the signature digitally. The remaining items go into your notes on the day of treatment. Pabau, practice management software for aesthetic practices, stores those details against the same appointment as the signed consent. The two columns below split the form’s job from the note’s.

How to use the Fillmed consent form in your practice

The workflow runs in five steps, and only the first two happen on the PDF itself.

1. Screen before you book the treatment. Walk through the contraindication list at consultation. If one applies, stop and either seek GP clearance or decline. Recording that decision protects the patient and the practice.
2. Take consent on the day. Read the disclaimer, the risks and the aftercare with the patient. Then have them answer the 11 questions, complete the free-text sections, and sign.
3. Record the product and the batch in your notes. Write the exact Fillmed product, the batch or lot number, and the expiry date. Do it at the point of use, not from memory afterward.
4. Record technique, sites and volumes. Note each area treated, the volume or number of passes per area, and the needle, cannula or device settings used.
5. Hand over aftercare and book the review. Give the patient the aftercare page, then set a review date. Two weeks suits dermal filler, and three to four weeks suits NCTF mesotherapy.

Steps three to five are where paper systems leak. A structured treatment record prompts for each field before the note can be closed.

Documenting Fillmed NCTF 135 HA treatments

NCTF 135 HA is a skin booster rather than a filler. It combines hyaluronic acid with vitamins, amino acids and coenzymes, delivered by mesotherapy. The goal is skin quality over several weeks, not immediate volume.

Your NCTF note should record the batch number and expiry date, any dilution used, the number of passes, and the injection depth. Add the total volume and the areas treated, which are usually the face, neck and décolletage.

Results build over three to six weeks as hydration and collagen remodeling improve. Set a review at two to four weeks, and photograph the skin so texture change is measurable later.

Documenting Fillmed Art Filler treatments

Art Filler is the dermal filler range, used for volume and contour. It includes Art Filler Universal, Lips, Volume, Fine Lines and Lips Soft.

Hyaluronic acid filler lasts roughly 9 to 18 months, and placement is anatomically precise. Record the exact product rather than the range name, along with the batch number and the volume per syringe. Note the volume placed at each site. Record whether you used a needle or a cannula, and the gauge or cannula size.

Before and after photographs are standard of care for filler work, and the consent form already covers clinical imaging. Pabau’s before-and-after photo tools store those images in the patient record, time-stamped against the treatment date.

Documenting Skin Perfusion and Nanosoft sessions

Skin Perfusion is Fillmed’s professional serum line, applied topically rather than injected. Record which serum you used, the date, the area treated, and whether it followed a procedure or stood alone.

Nanosoft is a microneedle device that delivers NCTF or compatible serums into the superficial dermis. Its settings are part of the protocol, so log the needle depth in millimeters and the number of passes.

Both are usually delivered as a course, so record the session number every time. Note the patient’s comfort during the session, plus any redness or swelling before they leave.

Batch traceability and record retention in the UK

Fillmed injectables are regulated as medical devices in the UK. Batch-level records are what let you act if the MHRA or the supplier announces a recall.

The treatment note is the only document linking a patient to a specific batch and date. Without it, you can’t tell a patient whether their product was affected. CQC inspectors ask aesthetic practices for exactly this trail.

Under UK GDPR and ICO guidance, health records must be held securely and kept for a defined period. Aesthetic practices commonly retain an adult record for eight years after the last appointment. A child’s record is usually kept until their 25th birthday.

Suspected adverse incidents involving a Fillmed product are reported to the MHRA through the Yellow Card scheme. You will need the product, the batch number and the treatment date to file one.

Digital and paper Fillmed records compared

A paper consent in a filing cabinet is hard to find when a patient calls three weeks later about a lump. It also carries no audit trail, so you can’t show who completed it or when.

Stored digitally, the same form gets a timestamp, a named author and encryption that meets UK GDPR expectations. Pabau’s compliance tools hold the signed consent, the clinical note and the photographs together.

The difference shows most during a recall. A digital record lists every patient treated with one batch in seconds, instead of a morning spent opening folders.

Fillmed documentation checklist

Work through this the first few times, and it becomes habit. The first list belongs on the form, the second in your clinical note.

On the consent form

• ☐ Contraindications read with the patient, and none apply
• ☐ Side effects and risks discussed, including vascular occlusion
• ☐ Aftercare page given to the patient
• ☐ All 11 screening questions answered
• ☐ Free-text sections completed, including aims and previous treatment
• ☐ Patient signature and date captured, on paper or digitally

In the patient record

• ☐ Exact Fillmed product name, not just the range
• ☐ Batch or lot number and expiry date
• ☐ Areas treated
• ☐ Volume or number of passes per area
• ☐ Needle, cannula or device settings
• ☐ Before and after photographs
• ☐ Practitioner sign-off with a timestamp
• ☐ Review appointment booked
• ☐ Any complication or concern reported afterward

How Pabau turns a Fillmed consent form into a record

The usual setup prints the consent, files it, then records the treatment detail somewhere else. Consent and clinical record drift apart, and the batch number is what goes missing.

With Pabau you rebuild this form once as a digital intake and consent form. The patient completes it on a tablet or before they arrive, and the answers, signature and timestamp attach to that appointment.

The treatment note then sits beside it, holding the product, batch, sites and volumes. When a recall lands you search by batch and get the patient list, then send letters from the same screen.

Every Pabau subscription includes all of it, from e-signature and photo storage to access controls and retention. Onboarding is structured, so the form is live before your next Fillmed treatment day.

Keep Fillmed consent and batch records together

Pabau stores signed Fillmed consent, batch numbers and treatment photographs against the same appointment. You can trace a batch to its patients in seconds, and show that aftercare was given.

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Conclusion

The form on this page is a solid consent document and not a treatment record. Be clear about which job it does, and the rest of your paperwork falls into place.

The detail that decides a recall or an inspection is the batch number, and no consent form will capture it for you. Record it at the point of use, every time.

Practices that keep consent and treatment detail in one system stop losing that trail. Book a demo to see how Pabau keeps Fillmed consent, batch records and aftercare in a single patient file.

Continue your research

Need a consultation form to pair with this consent? Med spa consultation form template gives you the pre-treatment questions that sit in front of a Fillmed consent.

Auditing your practice against UK duties? Medical spa compliance checklist walks through consent, retention and traceability obligations line by line.

Want consultations that convert? The importance of consultations shows how to set expectations before a filler appointment is booked.

Choosing software for an aesthetics practice? Best aesthetic clinic software compares the systems that store consent, notes and photographs in one record.

Frequently asked questions