Patient Consultation Record

If you have any allergic reactions to any of the ingredients, please avoid the treatment. If you tend to develop keloids or granulomas, have inflamed or infected skin, or general infection, you should forego treatment. Dermal fillers should not be injected over permanent implants. Please inform your practitioner before treatment if you are taking anticoagulants. Your practitioner can decide whether treatment is suitable for you. 

Pregnant women, breastfeeding mothers or adolescents under 18 years of age should not be treated with dermal fillers.

Please inform your practitioner of any disease you have or have had. These include in particular cardiovascular diseases, coagulation or blood disorders, autoimmune diseases, diabetes, skin infections, epilepsy, liver or kidney problems, a tendency to form keloids or scars, or allergies. If you take any medications or health supplements, have had cosmetic procedures or previous treatment with other implantation materials and had any complications, please inform your practitioner. 

NOTE: 

At Luxe Lips, we take the health and well-being of our clients seriously so at this time if you are sick with fever, runny nose, cough, and any other symptoms of flu - these can be isolated symptoms- we kindly ask that you reschedule. 

We know that rescheduling your appointment may be frustrating but due to the nature of the current situation it is simply not worth putting others at risk.

Thank you so much for understanding!

Privacy statement: Data collected is for clinic use only. If you have any concerns regarding the use of personal information, please contact Luxe Lips. 

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376 Chapel St. South Yarra

248 Sunshine Ave, Kealba

1 Thornton Close, Hallam

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