Prior to receiving treatment, I have been candid in revealing any condition that may have bearing on this procedure, such as: pregnancy, recent facial surgery, allergies, tendency to cold sores/fever blisters, and use of Retin-A, Renoca, Differin, Tazorac, Avage, and/or Accutane

I understand there may be some degree of discomfort, i.e: stinging, pinpricking sensation, hotness, or tightness.

I understand there are no guarantees as to the results of this treatment due to many variables such as: condition of the skin, sun damage, smoking, climate, etc.              I understand that each time I receive treatment, I may or not peel, and that each case is individual. 

I understand that to achieve maximun results, I may need several treatments. I understand that although complications are very rare, sometimes they may occur and that prompt treatment is necessary. In the event of any complications, I will immediately contact the esthetician who performed the treatment. 

I agree to refrain from tanning in tanning booths while I am undergoing treatment.

I understand that direct sun exposure is prohibited while I am undergoing treatment and that the use of sunblock and/or sunscreen with minimum of SPF 15 is mandatory. 

I have not had any other chemical peel of any kind, within 14 days of treatment. I understand I cannot have another treatment within 14 days of this treatment, whether it is performed at this location or any other locations.

I hereby agree to all of the above and agree to have this treatment be performed on me. I further agree to follow all post care instructions as I am directed.