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Chemical Peel Informed Consent

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SPA SALDO Client Forms

Chemical Peel Informed Consent

Personal Information
About the Treatment

Chemical peeling is a technique used to improve discoloration and smooth the texture of the skin by removing outer layers. A chemical solution is applied to the skin, which causes separation, peeling, and regeneration. The new skin may appear smoother, clearer, and less wrinkled. It may help with facial blemishes, enlarged pores, fine lines, wrinkles, uneven tone, and discoloration. Chemical peels are not a substitute for surgery and will not prevent or slow the aging process. Daily sunscreen use is critical after a peel.

Risks & Complications
  1. While improvement is anticipated, the exact level of improvement cannot be accurately predicted.
  2. There may be swelling, discomfort, tightness, scabbing, peeling, pinkness, or redness. Redness may persist for a longer period and scarring is possible.
  3. Not all clients visibly peel after a chemical peel. Lack of peeling does not mean the desired effect has not been achieved.
  4. Chemical peeling agents may permanently change natural skin color, including lighter or darker areas. Permanent darkening can occur.
  5. Infection is unusual but bacterial, viral, or fungal infections can occur. If you have a history of herpes simplex/cold sores, an outbreak may recur and preventive medication may be recommended.
  6. Treated skin may be sensitive for several days to several weeks. Excessive sunlight must be avoided and broad-spectrum sunscreen is required starting immediately post-treatment.
  7. A peel may not completely improve skin concerns or prevent future wrinkling. Additional treatments may be needed to reach specific goals.
Photographs

Treatment photos may be taken before treatment to monitor progress and may become part of the client record. No photograph or digital image that reveals my identity will be used publicly without my consent.

Additional Medical Notes
Client Consent

I am not pregnant or acutely ill, and I do not have significant skin disease, neurologic disease, or known allergies to peel ingredients. I will inform my provider if I have had facial surgery, allergies, a tendency to cold sores/fever blisters, or use topical or oral prescription medications such as Tretinoin, Retin-A, Accutane, Differin, Tazorac, Avage, EpiDuo, or Ziana.

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