CHEMICAL PEEL CONSENT FORM

DATE*

Date

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

I understand my skin may experience temporary irritation, tightness, or redness. These are all normal reactions that typically resolve within 72 hours depending on skin sensitivity.*

I understand all clients experiences may vary and some clients may experience a delayed onset of these symptoms.*

I understand that I may have some peeling after my treatment which should subside within a week.*

I understand the skin is more susceptible to sunburn/sun damage after treatment. I will void excessive sun exposure and use a minimum of SPF 40 sunscreen.*

I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols that are not part of the recommended regimen in the treated areas for minimum 2 weeks pre/post treatment.*

I understand photos may be taken before, during and after the treatment. Photos will only be used for education, promotion or advertising purposes.*

This consent form is valid for all future treatments and I will alert the staff if there are any future changes to my medical history.*

The information provided has been explained to me and all my questions have been answered to my satisfaction. I have read the above information, and I give my consent to have the hydrodermabrasion treatment by the staff at LUX BODY LAB.*

SIGNATURE*

PARENTAL SIGNATURE (IF UNDER 18 YEARS OF AGE)