Patient Consent

Prior to receiving treatment, I have been candid in revealing any condition that may have bearing on this procedure, such as: pregnancy (if so, consult your physician prior to treatment), recent facial surgery, allergies, tendency to cold sores/fever blister, or use of topical and/or oral prescription medications such as Tretinoin, Retin-A, Isotretinoin, Accutane, Differing, Tazorac, Avage, EpiDuo or Ziana.

I understand there may be some degree of discomfort, such as tingling, stinging, pin-prickling, sensation, heat or tightness.

I understand there are no guarantees as to the result of any treatment, due to many variables, such as: age, condition of skin, sun damage, smoking, climate, etc.

I understand this treatment is a cosmetic treatment and that no medical claims are expressed or implied.

I understand that in order to achieve maximum results, I may need several treatments.

I understand that although complications are very rare, sometimes they may occur and that prompt treatment is necessary. In the event of any complications, I agree to immediately contact the clinician who performed the treatment.

I agree to refrain from tanning in tanning beds or outdoors while I have undergoing treatment and during the 14 days prior to and following the end of treatment. This practice should be discontinued due to increased risk of skin cancer and signs of aging.

I understand that extended direct sun exposure is prohibited while I am undergoing treatment and the daily use of sunscreen protection with a minimum SPF of 30 is mandatory.

I have not had any other chemical peel of any kind within the past 14 days prior to treatment. I understand that I cannot have another chemical peel within 14 days after treatment, whether performed at this location or any other location.

I understand that I should follow my clinician’s recommendations for post procedure skin care to minimize side effects and maximize results.