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Intramuscular (IM) Injection Consent Form

I understand that the risks involved with injections include, but are not limited to, discomfort at the site of the injection, possible bruising, redness and swelling around the site, bleeding at the site, and rarely, an infection at the site of the injection. I understand risks and benefits of the injection. I have discussed all questions and concerns with my medical provider at Mi Amaur Aesthetics and have no further questions or concerns at this time.

My signature below confirms that:

1. I understand the information provided on this form and agree to the all statements made above.
2. I have received all the information and explanation I desire concerning the procedure.
3. I authorize and consent to the performance of Intramuscular (IM) Injection.
4. I understand this treatment may not meet my desired needs or expectations and further treatment may be required.
5. I release MI AMAUR AESTHETICS, and all the medical staff from all liabilities for any complications or damages associated with my Intramuscular (IM) Injection.
I do hereby consent to an intramuscular injection of: (have check boxes for each item below so the client can select the product)

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