Chemical Peel Agreement — Glo Aesthetics

Email

I acknowledge there may be some degree of discomfort during application. I will notice a warm sensation and the skin may tingle or sting and I may feel pin pricking, heat (burn) or tightness

Initial below

I have been advised that my treatment is exfoliation consisting singly, or a combination of Salicylic Acid, Lactic Acid, Glycolic Acid, Resorcinol, Trichloroacetic Acid, Retinoic Acid or Enzymes

Initial below

I consent to the chemical exfoliation treatment discussed with my Skincare Professional and fully understand all risks associated.

Initial below

I understand that pulling or picking the skin may lead to infection or scarring, and peeling and flaking may be present for 7-10 days.

Type initials below to confirm you read and understand.

Digital Signature

I understand no guarantee can be given as to final results, and several treatments may be needed to improve the skin condition. I certify that I have read and fully understand the above information, and that I have had sufficient opportunity for discussion. All my questions have been addressed and answered to my satisfaction. I acknowledge there are no guarantees as to the results of this treatment, due to many variables, such as: age, condition of skin, sun damage, smoking, hormones, lifestyle, climate, etc. I understand I may or may not actually peel, and that each case is individual By entering your Name below, you have read this consent form in its entirety and agree with everything answered above as well as receiving services from GLO Aesthetics

Chemical Peel Consent Forms