BOTOX® Medication Guide Acknowledgement

BOTOX Medication Guide Acknowledgement

Due to the fact that there are now multiple Botulinum Toxin, Type A products on the market, the FDA has required that all Botulinum toxin, Type A products carry a black box warning label to alert the public of possible adverse reactions or side effects of the toxins, as well as proper use of the toxins, and risk factors associated with there use. This is due to the fact that not all Botulinum toxins are created equal, and the public has a right to be made aware of the differences associated with each toxin that is available to you for injection. The 3 Botulinum toxins now available are Botox®, Dysport®, and Xeomin®. This form attached behind is the black box warning that is now required to be present on all BoNT-A package inserts. It is important to note that the every brand of BoNt-A is now required by the FDA to include the black box warning on all of there package inserts as well.

Please read the following form, which is the black box warning now on all package inserts of Botox®, Dysport®, and Xeomin® and sign the bottom stating we have made you aware of these new requirements by the FDA.