CHEMICAL PEEL CONSENT FORM
1. Treatment Description
A chemical peel is a skin-resurfacing treatment that uses a chemical solution to remove the outer layers of skin. It can help improve texture, fine lines, pigmentation, acne, and overall skin appearance.
2. Expected Benefits
Smoother and brighter skin
Reduction in mild pigmentation or uneven tone
Improvement in mild acne or congestion
Temporary tightening effect
I understand that results vary and multiple treatments may be required.
3. Possible Risks and Side Effects
I understand that chemical peels may cause:
Redness, dryness, tightness, or mild swelling
Peeling or flaking for several days
Temporary darkening or lightening of the skin
Sensitivity to sunlight
Breakouts or irritation
Rarely: infection, scarring, or allergic reaction
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I understand that these risks increase if I do not follow aftercare instructions.
4. Pre-Treatment Disclosure
I confirm that I have informed my practitioner of:
Pre-Treatment Disclosure
Any allergies or skin sensitivities
Any medical conditions
Any recent facial treatments, waxing, or exfoliation
Any use of retinoids, acne medication, or photosensitising products
Any history of cold sores or keloid scarring
If I am pregnant or breastfeeding
5. Aftercare Responsibilities
I understand that after the peel I must:
Avoid sun exposure and use SPF daily
Avoid picking or peeling the skin
Avoid heat, saunas, and strenuous exercise for 24–48 hours
Avoid exfoliating products until advised
Follow all aftercare instructions provided
6. No Guarantee of Results
I understand that results vary from person to person and that no specific outcome can be guaranteed.
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7. Consent to Treatment
I confirm that:
I have read and understood the information above.
I have had the opportunity to ask questions.
I understand the risks and benefits of the procedure.
I consent to receiving a facial chemical peel.
Client Name:
Date of Birth:
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2 digit day, 2 digit month, 4 digit year
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Address:
Email Address:
example@example.com
Phone:
Format: 00000000000.
Client Signature:
Date:
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2 digit day, 2 digit month, 4 digit year
Date
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