• I, give my full consent to Dr. George Kamajian to administer BOTOX® Cosmetic (onabotulinumtoxinA), Xeomin® (incobotulinumtoxinA) and/or Dysport® (abobotulinumtoxinA), on the following date.

  • Date Format: MM slash DD slash YYYY
  • Our goal is to meet or exceed your expectations on all procedures based on physician experience and your personal response to the toxin. If you feel the treatment is inadequate or unsatisfactory, it is our policy to offer additional Botox at the same price you originally paid. Please remember that Botox® Cosmetic, Xeomin® and Dysport® are cosmetic procedures and results are always subjective. Please maintain realistic expectations. By signing below gives your consent to this initial and all periodic treatments thereafter.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY