Post-Treatment Chemical Peels Form
Document your aftercare instructions and confirm acknowledgment after your chemical peel treatment.
Mild soap substitute
Moisturizer product name
Moisturizer application frequency per day
Additional instructions (Line 1)
Additional instructions (Line 2)
Additional instructions (Line 3)
Additional instructions (Line 4)
Client Name (printed)
*
Client Signature
*
Client Signature Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Esthetician Name
*
Esthetician Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: