Chemical Peel Consent Form

Chemical Peel treatments are not a cure-all treatment, but for appropriate conditions, can improve the skin. It is very important that you have a thorough understanding of what a Chemical Peel can and cannot do for you in a particular conition.

Please sign below if you understand the following:

I voluntarily consent and authorize Total Skin & More, LLC staff to perform a chemical peel treatment on my face or body part in order to treat the following conditions discussed with the Licensed Aesthetician;

The Chemical Peel treatment was/ will be explained to me by the Licensed Aethetician.

I understand that the degree of improvement I can expect to see is dependent on many varibles, and therefore cannot be guaranteed. Additionally, I understand that good home care and adherance to ALL instructions is vital to ensure my best results.

I understand that this is a series of treatments, and that I may need several treatments in order to achieve my best results.

I understand I may experience a burning or stinging senstation during and/ or immediately after the chemical peel has been applied.

I have not received any chemical hair treatments (permanent wave, straightening, relaxers, coloring or bleaching) or any waxing/ laser or Botox injections (in area that is to be treated) several days prior to this service.

I do not suffer from HIV, Viral Hepatitis, Herpes simplex (cold sores) infections or facial warts.

I have informed my Aesthetician if I suffer from diabetes.