Mirvaso consent form

Mirvaso treatments may cause several side effects that users should be aware of.

• Skin redness
• Burning sensation
• Itching
• Dry skin
• Flushing

Rare side effects can occur, including allergic reactions or severe skin irritation.

The ideal candidate for Mirvaso treatment typically experiences persistent facial redness due to rosacea.

• Adults with rosacea symptoms

• Individuals not pregnant or breastfeeding

• No known allergies to brimonidine or ingredients

• Absence of severe cardiovascular conditions

Not suitable for those with a history of certain skin conditions or hypersensitivity. Always consult a healthcare professional before starting treatment.

Proper aftercare is essential for the best results with Mirvaso.

• Avoid excessive sun exposure for at least 24 hours.

• Do not apply other skincare products immediately afterwards.

• Keep the treated area clean and dry.

• Monitor for any unusual reactions and consult your doctor if needed.

Always follow your healthcare provider's specific instructions.

To complete the consent form, carefully read each section outlining the treatment, potential risks, and expected outcomes. Ensure you understand all information before proceeding. Fill in personal details accurately and confirm agreement by ticking the required boxes. The form must be signed digitally to confirm your informed consent.