Logo

Chemical Peel

Consent Form

Chemical Peel Consent Form

Risks & Side Effects

Typical side effects of chemical peels are temporary and may include redness, dryness, stinging or burning sensations, and slight swelling. Deep peels might result in a permanent loss of the ability to tan.


However, chemical peels carry potential risks and severe side effects, such as:


  • Changes in skin color, including darkening or lightening, which may be more prevalent in individuals with darker skin tones.
  • Scarring.
  • Infections, particularly for individuals with herpes simplex, which might lead to flares post-treatment. In rare cases, chemical peels can cause fungal or bacterial infections.
  • Damage to vital organs like the heart, liver, or kidneys. Phenol, utilized in deep peels, can potentially harm the heart muscle, kidneys, and liver, causing irregular heartbeats.

It's important to note that chemical peels cannot be administered to individuals who have taken Accutane within the past 6 months.

Skin History

Please check any of the following that apply to you:

Client Details

Emergency Contact

Medical Information


Please check any of the following that apply to you

Contraindications

Please check all that apply to you

What to Expect After

Please initial beside each statement

Consent & Agreement

I acknowledge that the facial treatment does not replace medical treatment or advice. I have provided accurate information to the best of my knowledge. I consent to the facial treatment and agree to adhere to the technician's recommendations for aftercare and skincare. I release my technician and Beauty Oasis from any liability in the event of any inaccuracies in the treatment form.

Risks & Side Effects

Typical side effects of chemical peels are temporary and may include redness, dryness, stinging or burning sensations, and slight swelling. Deep peels might result in a permanent loss of the ability to tan.


However, chemical peels carry potential risks and severe side effects, such as:


  • Changes in skin color, including darkening or lightening, which may be more prevalent in individuals with darker skin tones.
  • Scarring.
  • Infections, particularly for individuals with herpes simplex, which might lead to flares post-treatment. In rare cases, chemical peels can cause fungal or bacterial infections.
  • Damage to vital organs like the heart, liver, or kidneys. Phenol, utilized in deep peels, can potentially harm the heart muscle, kidneys, and liver, causing irregular heartbeats.

It's important to note that chemical peels cannot be administered to individuals who have taken Accutane within the past 6 months.

Skin History

Please check any of the following that apply to you:

Client Details

Emergency Contact

Medical Information


Please check any of the following that apply to you

Contraindications

Please check all that apply to you

What to Expect After

Please initial beside each statement

Consent & Agreement

I acknowledge that the facial treatment does not replace medical treatment or advice. I have provided accurate information to the best of my knowledge. I consent to the facial treatment and agree to adhere to the technician's recommendations for aftercare and skincare. I release my technician and Beauty Oasis from any liability in the event of any inaccuracies in the treatment form.

Share by: