• I have read the information titled “About Juvederm Voluma XC” in its entirety and have discussed the risks and benefits of dermal filler treatment with my physician and his/her representative. I understand the information provided and realize that results are not guaranteed and can vary. I agree to my being treated with Juvederm Voluma XC. By also signing below gives your consent to this initial and all periodic treatments thereafter.
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  • I have discussed the risks and benefits of dermal filler treatment with this patient, have answered his/her questions, and find him/her an appropriate candidate for treatment with Juvederm Voluma XC.
  • Date Format: MM slash DD slash YYYY