• 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
  • 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
  • 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.
  • 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.
  • Date of Birth:
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  • Format: 00000000000.
  • Date:
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    2 digit day, 2 digit month, 4 digit year
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