Botox Patient Forms (fillable)

 Botox Post Treatment Instructions Forms

 Botox Patient Consent Forms

Have you heard of BOTOX? This is a brand name, In our opinion our brand Xeomin more effective, safer, and healthier for you. We now offer this at Ladner Dental Clinic, trained by medical Esthetic Specialists. 

 Xeomin  gives dentists a minimally invasive way to treat issues like temporomandibular joint disorders, gummy smiles, and teeth grinding.

Whether you’re looking to enhance your smile or alleviate jaw discomfort, come in for a “NO CHARGE CONSULT”. Please make sure this is right for you.  Find below to read CONTRAINDICATIONS. 

 Botox® Q & A’s:

1.What is Xeomin?

  • Xeomin(Botox) Cosmetic = brand name of neuromodulators 
  • Neuromodulators are used to relax muscle and soften wrinkles. 

2. What does treatment entail?

  • Neuromodulators are injected using a very small needle with minimal discomfort. 
  • Minimally invasive procedure that has little to no downtime 
  • Commonly treats frown lines, forehead lines and crow’s feet. 
  • Results in 10 days two weeks 
  • Duration of effect is on average 3-4 months.

3. What areas can be treated?

Xeomin is effective at softening forehead lines, frown lines, crow’s feet, bunny lines, lip lines, gummy smile, dimpled chin, square jaw, neck bands, and so much more.

4. When can I start Xeomin treatment?

  • The earlier a patient starts Xeomin the smoother their face will appear as they age. Regularly schedule Xeomin. 

      Can prevent future wrinkles from forming. Seniors may need several visits to get a change.

5.  What should I expect during the Xeomin treatment?

  • Dr. Shpak will discuss your treatment and performs a facial analysis to determine the appropriate treatment plan for you. Xeomin treatment takes only 10-15minutes and there is very little discomfort as we use the tiniest needles. 

6. How long will results last?

  • Results typically last 3 to 4 months. We recommend regular touch ups every 3 to 4 months to maintain optimal results. Xeomin is not a permanent treatment. If you discontinue treatment, the wrinkles will gradually return. 

7. How much does it cost?

  • The cost varies for each person depending on the areas being treat and the strength of your muscles. 
  • Average female forehead is 20-40 units; men are 30-60 units. 



  • Body dysmorphic disorder 
  • Neuromuscular disorders 
  • Coagulation disorders (I.e., hemophilia) 
  • Certain medications (i.e., aminoglycosides) 
  • Age<18 
  • Keloid scaring 
  • Breathing disorders 
  • Professional singers / wind instrumentalists 


What are Cosmetics Uses? 

Common Uses: 

  • Forehead Lines 
  • Frown Lines 
  • Crow’s Feet 

Other Uses: 

  • Mid and lower face injections 
  • Jaw Reshaping 



  • Side effects are very rare. 
  • Most common side effects. 


Absolute Contraindications 


  • Hypersensitivity to the product 
  • Infection at the site 
  • Pregnancy or trying to conceive. 
  • Breast feeding 
  • Cow’s milk allergy (Dysport® only)


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