Xeomin Treatment Consent Form – Austin City Dental
Please review and complete your Xeomin Consent
Before receiving Xeomin injections, we require all patients to complete this secure consent form. It explains how Xeomin works, what areas may be treated, possible side effects, and important safety information so you can make an informed decision about your care. Once submitted, your form is encrypted and sent directly to our team for review.
Please complete this form before your appointment so we can confirm that Xeomin is appropriate for your medical history and treatment goals.


