Chemical Peel Consent

Name*

First NameLast Name

Date

Do any of the following currently apply to you? *

Have you ever had a Chemical peel? *

Before and after photos are taken both for personal and advertising use. I am okay with my photos being shared on social media. (If you mark no, these photos will be confidential and only yourself and SKIN by Carli will see these photos) *

I understand that the Chemical Peel being used is a 20% Lactic Acid and is best used in a series of 6. This peel helps with brightening the skin, smoothing lines and wrinkles, lighten acne scarring, improves skin roughness. I also understand that every persons skin reacts differently and that results vary person to person. *

I agree that I have given SKIN by Carli all necessary information needed before going forth with the chemical peel and I will notify her immediately if anything comes up following my treatments.*

I agree that I will follow the recommended after care instructions of keeping my skin clean, exfoliating 2x weekly, keeping my skin deeply hydrated, staying out of the sun as much as possible and wearing sunscreen when exposed to the sun. *

I have asked all necessary questions I may have pertaining to the treatment. *

I give SKIN by a Carli permission to perform the Chemical Peel Treatment on my skin.*

Signature that the above is true and correct.*