MN The Metropolitan Clinic Kybella Consent Form 2015-2025 free printable template

Consent Name Date of Birth BELLA CONSENT FORM Bella (Deoxycholic acid) is the first and only FDA approved nonsurgical treatment that contours and improves the appearance of submental fullness. Bella

How to fill out kybella consent form

How to fill out MN The Metropolitan Clinic Kybella Consent Form

1. Begin by obtaining the MN The Metropolitan Clinic Kybella Consent Form from the clinic's office or website.
2. Carefully read through the information on the first page to understand the procedure and its risks.
3. Fill in your personal information such as your name, contact details, and date of birth at the designated section.
4. Review and answer any medical history questions truthfully to ensure your safety during the procedure.
5. Acknowledge the potential side effects and aftercare instructions by checking the appropriate boxes.
6. Sign and date the form at the bottom, confirming your understanding and consent for the Kybella treatment.
7. Submit the completed form to the clinic staff and retain a copy for your records if necessary.

Who needs MN The Metropolitan Clinic Kybella Consent Form?

1. Individuals seeking non-surgical fat reduction under the chin area should fill out the MN The Metropolitan Clinic Kybella Consent Form.
2. Patients who have scheduled a Kybella treatment at the Metropolitan Clinic are required to complete this form prior to the procedure.
3. Anyone considering the Kybella treatment who wants to understand the risks and benefits should review and sign the consent form.

People Also Ask about

Can Kybella go wrong?

Kybella's most common side effects are pain, swelling, and bruising where it was injected. Other injection site reactions are also common. Rare but serious side effects are also possible. This includes more serious injection site reactions, difficulty swallowing, and nerve damage.

What is the protocol for Kybella?

A single treatment consists of up to a maximum of 50 injections, 0.2 mL each (up to a total of 10 mL), spaced 1 cm apart. Up to 6 single treatments may be administered at intervals no less than 1 month apart.

What happens if Kybella is injected wrong?

“Kybella is a cytolytic drug, which when injected into tissue physically destroys the cell membrane. When properly injected into submental fat, the drug destroys fat cells; however, it can also destroy other types of cells, such as skin cells, if it is inadvertently injected into the skin,” ing to the FDA.

Who is not a candidate for Kybella?

However, good health and excess chin or neck fat alone are not enough to qualify. There are other factors that must be considered as well. For example, you will be considered a poor fit for this treatment if you are pregnant, nursing, or obese.

Is Kybella approved for bra fat?

An FDA-approved treatment, Kybella is typically used in the following area: The submental area, or under the chin. Upper back fat, or what they call the “bra bulge.”

Is Kybella damage permanent?

However, to others, a Kybella® treatment from an unskilled provider may result in permanent — and irreversible — nerve and/or muscle damage. Side effects of improperly administered Kybella® may include permanent facial muscle weakness, nerve injury to the jaw, or a lopsided smile.

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What is MN The Metropolitan Clinic Kybella Consent Form?

The MN The Metropolitan Clinic Kybella Consent Form is a legal document that patients must complete before undergoing Kybella treatments, which are used for reducing submental fat or double chin.

Who is required to file MN The Metropolitan Clinic Kybella Consent Form?

All patients who wish to receive Kybella treatments at The Metropolitan Clinic are required to file the Kybella Consent Form.

How to fill out MN The Metropolitan Clinic Kybella Consent Form?

To fill out the MN The Metropolitan Clinic Kybella Consent Form, patients need to provide their personal information, review the details of the procedure, acknowledge understanding of the risks, and sign the document.

What is the purpose of MN The Metropolitan Clinic Kybella Consent Form?

The purpose of the MN The Metropolitan Clinic Kybella Consent Form is to inform patients about the treatment, risks, and benefits, and to obtain their consent before proceeding with the procedure.

What information must be reported on MN The Metropolitan Clinic Kybella Consent Form?

The information that must be reported includes patient personal details, medical history, understanding of the Kybella procedure, potential risks and complications, and acknowledgment of consent.