Chemical Peel Wavier

Chemical Peel Wavier
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Contradictions:

1. Pregnancy/ Lactating

2.Herpes Simplex( Cold Sores/ Fever Blisters)

3. Extensive Sun or tanning 3 days prior or 3 days post treatment

4. Accutane in the last 6 months

5. Topical retinol products(perscription strength) in the past 3 days

6. Waxing of area to be treated in the past 7 days

7. Any other chemical peel within the last 14 days

8. Allergy to asprin
Initial that you understand the contradictions*
Risks and complications:

I am aware of the following:

1. Mild to moderate discomfort or pain

2. Slight redness or swelling

3. Sun sensitivity

4. Skin Sensitivity

5. Pigment changes

6. Scarring

7. Allergic reaction

8. Bacterial infection
Initial that you understand the Risks and complications*
I understand that the treatment may involve risks of complication or injury from both known and unknown causes, and I freely assume those risks. Prior to receiving treatment, I have been candid in revealing any condition that may have a bearing on this procedure. I consent and authorize Ashley Lynn Esthetics and its affiliates to perform one or more chemical peels on me. I certify that I have read this entire informed consent and I understand and agree to the information provided in the form. My questions regarding the procedure have been answered satisfactorily. I hereby release Ashley Lynn Esthetics and its affiliates, estheticians, or other employees from all liabilities associated with this procedure. This consent is valid for all of my chemical peel treatments in the future as well. I understand that due to time and materials there are no refunds on services rendered.*

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