Initial Consultation – Prescriber – Botox

You may be a prescriber, thinking of offering a prescribing service to your non-prescribing colleagues. Or maybe you’re looking for a prescriber for yourself and wondering what they’ll actually do when they see your clients? Although there is no guideline for this currently, here I’ll (Dr. Michael Aicken, Visage Aesthetics UK LTD) share my own process of conducting these initial consultations for the clients of other practitioners who I’m planning to prescribe on behalf of.

Recently Doctors and nurses have been uncovered by The Sunday Times for illegally prescribing Botox remotely despite the current guidelines requiring them to see patients face to face. I can not stress enough how important it is for your patients and yourself to follow the laws to ensure safe practice.

Before I start sharing the consultation procedure, I think it’s worth mentioning some other basics, which may help you avoid the confusion I’ve had myself or mistakes I have heard others making in the past. These mistakes are really about communication and expectations, rather than being specific to the medical aesthetics world.

Here’s a direct quote from my previous post “How to Hook a Prescriber”

“Have a written agreement between you, which lays out each other’s responsibilities. Think of this, not as a legal document, but an agreed plan of action, to be referred back to and edited together as your business relationship develops.”

Your agreement should cover the following, as a minimum:

1) Clients should pay upfront for your consultation service.

I’ve charged anywhere from £30 per consultation to £500 per hour for offering this depending on the number of people involved, whether it’s in my clinic or elsewhere and depending on travel time. It’s up to you and the clinic manager who is hiring you.

2) Written agreement

Include a sentence confirming that the practitioner for whom you are prescribing will not treat any client with any medication that you have prescribed until AFTER you have had a face-to-face consultation with them. Your career is at risk if the practitioner does not stick to this agreement, so it seems only logical to me to have this in writing to reduce the chances of misunderstanding over this detail. 

3) Insurance

Make sure you are insured to prescribe for these clients and make sure you see evidence of your practitioners insurance. Include a clause in your agreement that they agree to keep their insurance up to date.

4) Medical History

When seeing the client, to maximise your efficiency (or rather, to get the most benefit for the clinic who hired you), I recommend having the client complete their medical history form BEFORE seeing you. This can be done easily using a programme like Flourish. e.g. In Flourish the patient records will end up here: https://demo.flourishandgrow.com/patients  after completing a form like this: https://test.flourishandgrow.com/form

Additionally, if an assistant has taken before photos and stored these inside Flourish, another significant chunk of workload can be successfully delegated. A free trial on Flourish is available here: https://www.flourishandgrow.com/try-flourish/

5) Consultation

When seeing the client, with medical history and hopefully before images to hand, i’ll go through the following protocol in approximately 6 minutes per patient on average (10 per hour).

  • Introduce myself and explain the reason for the consultation
    • “I’m here to chat to you about any anti-wrinkle treatment or filler treatments that you have had in the past or are considering having in the future”.
  • Confirm their name and DOB
  • Ask “what treatments are you interested in having done”
  • Ask about any previous experiences on anti-wrinkle treatment and filler, enquiring about any side effects and follow-ups needed
  • Reassure them if possible, how these side-effects will be considered this time around
  • Advise how they will contact you if needed, if an issue can’t be resolved with their practitioner
  • Ask them to sign a consent form with you for each procedure (typically anti-wrinkle treatment and filler) – if they decline to sign both, advise that if they change their mind in future, they will probably have to return for another consultation
  • Make a note of all of the above. 
  • If done on paper, sign, add your full name, date and time. If using Flourish, all of this is logged automatically.

You may find these previous blog posts useful: