Neurotoxin & Dermal Filler
Informed Consent & Acknowledgment

Purpose of This Consent

This is a procedure-specific informed consent for injectable neurotoxin and dermal filler treatments. It is in addition to, and where it conflicts, controls over, the Navara Health General Aesthetic Informed Consent.

Authorization for Treatment & Provider Identification

I authorize the following clinicians at Navara Health, PLLC to evaluate me and perform neurotoxin and/or dermal filler injections as clinically appropriate:

• Jessica Boggs, MSN, APRN, FNP-C, ENP-C — delegating Advanced Practice Registered Nurse, treating provider, and clinical oversight
• Rocio Gonzalez, RN — Registered Nurse injector, performing injections under written APRN delegation, Good Faith Exam oversight, and medical director protocols, consistent with Texas Board of Nursing and Texas Medical Board rules

I understand and agree that:

• A Good Faith Exam (GFE) by the delegating APRN (in person or via permitted telehealth where appropriate) will be completed prior to my first injectable treatment and as clinically indicated for subsequent visits
• The GFE assesses my candidacy, medical history, contraindications, and treatment plan
• Injections may be performed by either Jessica Boggs APRN or Rocio Gonzalez, RN under appropriate delegation and oversight
• I may request to be seen by a specific provider; that request will be accommodated when possible
• Either clinician may decline to perform a requested treatment if it is clinically inappropriate or unsafe

Products & Treatment Description

Products Used at Navara Health

I understand that the specific product, dose (units for neurotoxin or mL for filler), and injection sites will be selected by my injector based on my anatomy, goals, and clinical judgment, and will be discussed with me prior to injection.

Expected Results & Onset / Duration

Neurotoxins

• Onset typically begins 3–7 days post-injection
• Peak effect occurs at approximately 10–14 days
• Duration of effect varies by product, dose, metabolism, and treatment area

Typical Duration by Product

• Botox®, Dysport®, Jeuveau®, Xeomin®, Letybo®: approximately 3–4 months (90–120 days)
• Daxxify®: may last longer (up to approximately 6 months) in some patients, though duration varies and is not guaranteed

FDA Approval & On-Label vs. Off-Label Use

• Botulinum toxin products are FDA-approved for specific cosmetic indications that vary by product, commonly including glabellar lines ("11s"), crow's feet, and forehead lines
• Injection into other areas — including masseters, neck (platysmal) bands, chin, lip flip, brow lift, gummy smile, underarms, or other medical or aesthetic indications — is considered off-label for some products
• Off-label use is legal, common, and accepted in aesthetic medicine, and is at the provider's clinical discretion
• No guarantees are made regarding cosmetic outcome, symmetry, or longevity

Treatment Continuity

• Repeated treatments are required to maintain results
• Initial treatments may have shorter duration; results may extend with consistent treatment
• Long-term improvement in dynamic wrinkles may occur with consistent use, but no permanent effect is guaranteed

Dermal Fillers

• Volume effect is immediate; final result settles over 2–4 weeks as swelling resolves and product integrates
• Typical duration ranges from 6 months to 2+ years depending on product, area, metabolism, and lifestyle
• HA filler can be partially or fully dissolved with hyaluronidase if needed for adjustment or complication
• Some products are biostimulatory (not pure HA) and cannot be dissolved with hyaluronidase

Risks & Possible Complications — Neurotoxins

Risks & Possible Complications — Dermal Fillers

Contraindications & Precautions

I should not receive neurotoxin or filler treatment, or treatment may be delayed/modified, if I have or disclose:

• Pregnancy, possible pregnancy, or breastfeeding
• Active skin infection, acne flare, cold sore, or open wound at or near the injection site
• Active sinus infection (caution with midface/cheek filler)
• Known allergy or hypersensitivity to the proposed product or its components (including lidocaine in pre-mixed fillers)
• History of severe allergic reaction to any aesthetic injectable
• Neuromuscular disorders (myasthenia gravis, Lambert-Eaton syndrome, ALS) — neurotoxin contraindicated
• Significant swallowing or breathing disorders — neurotoxin contraindicated
• Receiving botulinum toxin injections elsewhere in my body (medical or cosmetic) without full disclosure to Navara Health
• Bleeding disorders or current anticoagulant therapy (increased bruising risk)
• Recent or upcoming dental procedures (caution within 2 weeks before/after filler)
• Recent or upcoming vaccinations (caution within 2 weeks before/after filler)
• Autoimmune disease (caution; case-by-case review)
• History of keloids or hypertrophic scarring
• Significant facial asymmetry or congenital ptosis
• Unrealistic expectations
• Body dysmorphic concerns

Pre- and Post-Procedure Responsibilities

Before Treatment

• Disclose all medications, supplements, blood thinners, recent procedures, and vaccinations
• Avoid NSAIDs, fish oil, vitamin E, ginkgo, garlic supplements, and alcohol for 48–72 hours before (unless medically required)
• Notify injector of cold sore history (prophylactic antiviral may be recommended)
• Avoid waxing, dermaplaning, peels, or lasers in the treatment area for at least 1 week before
• Arrive with clean skin, free of makeup if requested

After Neurotoxin

• Remain upright for at least 4 hours
• Avoid rubbing, massaging, or applying pressure to treated areas for 24 hours
• Avoid strenuous exercise, saunas, hot tubs, and significant heat exposure for 24 hours
• Avoid lying face-down or on the treated area for 24 hours
• Avoid additional facial treatments (peels, lasers, massage) for at least 2 weeks
• Expect onset over 3–14 days; do not request "more" before the 14-day mark

After Dermal Filler

• Avoid touching, rubbing, or pressing on treated areas for 24–48 hours
• Apply cold compresses gently to reduce swelling
• Avoid strenuous exercise, alcohol, saunas, and hot tubs for 24–48 hours
• Avoid dental procedures and facial treatments for at least 2 weeks
• Sleep with head elevated for 1–2 nights
• Final result may take 2–4 weeks; do not request touch-up before then
• Maintain proper sun protection (SPF 30+) during recovery

Off-Label Use Disclosure

Some neurotoxin and filler uses are off-label, meaning they have not received specific FDA approval for that indication, even though the product is FDA-approved for other uses. Off-label use is legal, common, and accepted in aesthetic medicine and is at the provider's clinical discretion. Examples include:

• Neurotoxin for masseter slimming, lip flip, neck (Nefertiti) lift, gummy smile, chin dimpling, platysmal bands, hyperhidrosis sites beyond the underarms
• Filler use in lips, chin, jawline, tear troughs, hands, earlobes, or other off-label sites depending on the specific product's labeling

Financial Disclosure

I understand and agree that:

• Neurotoxin and filler treatments are elective and not covered by insurance
• Navara Health is a cash-pay practice and does not bill, verify, or submit claims to insurance, Medicare, or Medicaid for aesthetic services
• Payment is due at the time of service
• No refunds are issued once a syringe has been opened or any product has been injected
• If a touch-up is needed within the provider's standard touch-up window, additional cost may apply
• Treatment of complications, including hyaluronidase reversal, prescription medications, antibiotics, or specialty referral, may incur additional cost that is my financial responsibility
• Pre-paid packages and memberships are non-refundable except as expressly stated in writing

Communication & HIPAA Authorization

I authorize Navara Health to communicate with me regarding scheduling, pre/post-procedure instructions, follow-up, and adverse event reporting through:

• The secure HIPAA-compliant patient portal
• Email to the address I have provided
• SMS / text message to the mobile number I have provided
• Telephone calls to the number I have provided

I understand that email and SMS are not fully secure channels. I may revoke authorization for any specific channel in writing to contact@navarahealthtx.com, except where required for legally mandated notices.

Assumption of Risk & Release of Liability

I voluntarily assume all known and unknown risks associated with neurotoxin and dermal filler treatment. To the fullest extent permitted by law, I agree to release, indemnify, and hold harmless Navara Health, PLLC, Jessica Boggs APRN, Rocio Gonzalez RN, the medical director, and all affiliated providers, nurses, contractors, and staff from liability related to:

• Adverse reactions or complications
• Side effects, asymmetry, or atypical product response
• Cosmetic dissatisfaction with the result
• Need for additional, corrective, dissolution, or maintenance procedures
• Conditions not disclosed prior to treatment

This release does not apply to cases of gross negligence or willful misconduct, and does not waive any right that cannot lawfully be waived under the laws of the State of Texas.

Dispute Resolution & Binding Arbitration

Any dispute, controversy, or claim arising out of or relating to this Consent, the procedure performed, or the practitioner-patient relationship — including any claim of medical malpractice, billing dispute, or breach of contract — shall first be addressed by good-faith negotiation between the parties.

If the matter cannot be resolved through negotiation within thirty (30) days, the parties agree to submit the dispute to binding arbitration administered by a recognized arbitration body (such as the American Arbitration Association) under its applicable rules, with the arbitration to take place in Dallas County, Texas.

The parties acknowledge that by agreeing to arbitration, they are waiving the right to a jury trial. This provision does not waive any right that cannot lawfully be waived under Texas law. Either party retains the right to seek injunctive or equitable relief in court where appropriate.

Governing Law & Severability

This Consent shall be governed by and construed under the laws of the State of Texas. If any provision is found unenforceable, the remaining provisions shall remain in full force and effect.

Photography & Marketing Authorization

Photographs taken before, during, and after injectable treatments serve different purposes, and I am being asked to provide separate consent for each use. I understand I may consent to medical documentation while declining marketing use, or vice versa.