Juvederm Voluma Consent FormI have read the information titled “About Juvederm Voluma XC” in its entirety and have discussed the risks and benefits of dermal filler treatment with my physician and his/her representative. I understand the information provided and realize that results are not guaranteed and can vary. I agree to my being treated with Juvederm Voluma XC. By also signing below gives your consent to this initial and all periodic treatments thereafter.Patient SignatureDate* MM slash DD slash YYYY I have discussed the risks and benefits of dermal filler treatment with this patient, have answered his/her questions, and find him/her an appropriate candidate for treatment with Juvederm Voluma XC.Signature of Physician or Physician’s RepresentativeDate* MM slash DD slash YYYY CAPTCHA