Chemical Peel

Client Informed Consent Form

You have the right to be fully informed about your condition and the treatment options available to you. This allows you to make an educated decision about whether or not to proceed with the procedure, with a clear understanding of any potential risks and side effects. The information provided here is to help you make an informed choice—it is not intended to cause alarm.

• I voluntarily consent to undergo a chemical peel procedure, understanding that this cosmetic treatment is designed to remove the outer layers of the skin to enhance its overall appearance and vitality.

• While chemical peels are effective and generally safe, they are not without potential side effects. Redness (erythema) and swelling (edema) may occur in the treated area but typically subside within a few hours. However, these effects can last up to seven days or longer. Additionally, irritation, itching, mild burning, or discomfort similar to sunburn may arise within 48 hours post-treatment.

• I understand the importance of using sunscreen with a minimum SPF of 40 to protect my skin from sun exposure following the procedure.

• I acknowledge that there are possible complications, which may include whiteheads, cold sores, infections, scarring, numbness, or permanent changes in skin color.

• I am aware that no specific outcome is guaranteed, and individual results may vary. Multiple treatments may be necessary to achieve the desired results. I agree to follow all safety protocols and guidelines throughout the treatment process. I also understand that no refunds will be issued for treatments that have been provided.

• I confirm that I have received and understand the Pre- and Post-Treatment Care Instructions, and I commit to following these guidelines closely.

• I certify that I am not currently using retinoids, Retin-A, or other active ingredients that could potentially cause complications during the peel, such as increased sensitivity, burning, or peeling.  

• I understand that all services provided will be billed directly to me, and I accept full responsibility for payment.

• The nature and purpose of the chemical peel procedure have been clearly explained to me. I have had the opportunity to ask any questions, and they have been answered to my satisfaction. I fully understand and agree to the terms of this consent form. Alternative treatments and their potential risks and benefits have been discussed with me, and I am aware of my right to decline the procedure.

• Note: All prices are subject to change without prior notice