BioRePeel Blue/Gold Consent Form

PRE-TREATMENT GUIDELINES

I, {name}, understand and agree that before my BioRePeelCl3 treatment, I will:

• Avoid topical retinoids, tretinoin, and strong skincare active products for at least 7–14 days.
• Avoid other acids/exfoliants (AHA/BHA, scrubs, at-home peels, exfoliating brushes/devices) for at least 7–14 days.
• Avoid laser hair removal and other laser treatments on the area for 4–6 weeks.
• Avoid waxing, threading, or chemical hair removal creams on the area for 7 days.
• Avoid Botox or dermal fillers in the area for 7 days.

Please initial here:*   

WHAT TO EXPECT

 I, {name}, understand that:

• During my BioRePeelCl3 treatment I may experience warmth, tingling, or mild stinging.
• After the treatment I may experience temporary redness, tightness, light flaking or peeling, or a feeling similar to a mild sunburn.
• These reactions are usually short-lived and improve over several hours to a few days, depending on my skin and treatment plan.
• Best results are usually seen after a recommended series and it may take 4–6 weeks after my series for my skin’s renewal cycle to complete.

No specific result is guaranteed.

Please initial here:*   

POTENTIAL RISKS

I, {name}, understand that, although rare, chemical peels can have complications, including but not limited to:

• Breakouts or whiteheads.
• Cold sores (if I have a history).
• Infection.
• Hyperpigmentation or hypopigmentation (darkening or lightening of the skin).
• Scarring or changes in skin texture.
• Prolonged redness, swelling, or sensitivity.
• Allergic reaction to any product used.

I understand that following pre- and post-care instructions greatly reduces these risks.

Please initial here:*   

POST-TREATMENT GUIDELINES

I, {name}, agree to follow the post-care instructions provided to me, including:

• Cleansing with a gentle cleanser as directed.
• Avoiding non–mineral-based makeup for 24–72 hours after treatment.
• Avoiding the gym and heavy sweating for at least 24 hours; avoiding hot yoga for 24–72 hours.
• Avoid all exfoliation and active products for 7 days, including AHA/BHA acids, retinol/retinoids, scrubs, and exfoliating devices.
• Avoiding laser hair removal on the treated area for 4–6 weeks.
• Avoiding waxing/threading for 7 days after treatment.
• Avoiding saunas, steam rooms, and swimming for approximately 7 days.
• Using recommended products such as hydrating serums/creams (e.g., BioReHydra and BioReLift) morning and evening as instructed.
• Using a broad-spectrum SPF 50+ daily and limiting direct sun exposure while in a peel series and afterward.

I understand that neglecting post-care can increase the chance of irritation, pigmentation changes, or other complications.

Please initial here:*   

I voluntarily request that GT Lash And Brows perform the BioRePeelCl3 TCA chemical peel procedure. I acknowledge having been informed that this cosmetic procedure is intended to remove surface layers of the skin to improve the vitality of the skin. 

I understand that temporary reactions can occur. These may include redness (erythema) and mild swelling (edema), which typically resolve within a few hours, but may last up to 7 days. I may also experience tightness, dryness, mild peeling, itching, and/or a warm or sunburn-like sensation, especially within the first 48 hours.

I understand that daily SPF is required, and I agree to use a broad-spectrum sunscreen SPF 50+ and limit direct sun exposure before and after my treatment to reduce the risk of irritation or discoloration.

I understand that while uncommon, possible complications can include breakouts/whiteheads, cold sore flare-ups, infection, scarring, temporary or permanent skin discoloration, and/or numbness.

I understand that no guarantee, warranty, or assurance has been made to me as to the results that may be obtained. I am aware that follow-up treatments may be necessary for desired results. I understand that most patients require a few treatments over time and that skin improvements are typically gradual. I understand that clinical results vary per patient. I agree to adhere to all safety precautions and regulations during the treatment. I understand that no refunds will be given for treatments received.

I confirm that the pre- and post-treatment instructions have been explained to me, and I agree to follow them carefully.

I CERTIFY that I am not using any retinal, Retin-A, or other active skincare ingredients and understand that the products may cause minor complications during the peel process including increased sensitivity, burning sensations, and peeling.Please initial here:*   

I understand and agree that all services are charged to me directly and that I am personally responsible for payment in full.

I further grant GT Lash And Brows and its affiliates the unrestricted right to photograph my face, including before-and-after images, and to use these images in any form of media (print, digital, electronic, or otherwise) for advertising, marketing, education, publicity, archival, or other lawful purposes. I waive any right to compensation or royalties and release GT Lash And Brows from any liability associated with the taking or use of these images.

I acknowledge that the nature and purpose of this treatment have been explained to me. I have read and understand this agreement. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I understand there are alternative treatments available and I have the right to refuse treatment.

I understand that this consent applies to this service and all future BioRePeelCl3 treatments provided by any professional at GT Lash And Brows. I confirm that I have read and fully understand this agreement and that I am signing it voluntarily.

I certify that I am 18 years of age or older, or that a parent/legal guardian has provided consent below.