CHEMICAL PEEL CONSENT FORM

CHEMICAL PEEL CONSENT FORM

 

 

MEDICAL HISTORY:

Procedure Description:

 

I understand that I am receiving a chemical peel treatment. A chemical peel is a cosmetic procedure that involves the application of a chemical solution to the skin to exfoliate the outermost layers. This process promotes cell turnover, improves skin texture and tone, and reduces the appearance of wrinkles, acne scars, and hyperpigmentation.

 

Benefits and Risks:

 

I have been informed that the benefits of a chemical peel may include:

  • Smoother, more radiant skin

  • Improvement in skin texture and tone

  • Reduction in the appearance of fine lines, wrinkles, and hyperpigmentation

  • Diminished acne scars or blemishes

 

I understand that there are potential risks and side effects associated with a chemical peel, including:

  • Temporary redness, swelling, and/or itching

  • Sensitivity or discomfort during and after the treatment

  • Peeling, flaking, or crusting of the skin

  • Changes in skin pigmentation

  • Infection (rare, but possible)

 

Aftercare:

 

I agree to follow the post-treatment instructions provided by the clinician to ensure the best possible results and minimize any risks. I understand that failure to adhere to these instructions may increase the likelihood of complications.

 
Consent for Treatment:

I hereby consent to undergo a chemical peel treatment. I acknowledge that the clinician has explained the procedure, its benefits, and potential risks to me. I have had the opportunity to ask questions, and all of my concerns have been addressed to my satisfaction. I understand that the results of a chemical peel can vary, and multiple sessions may be required for optimal results.

 

Release of Liability:

I release Thrive Aesthetics, its employees, and representatives from any liability associated with the chemical peel treatment, except for cases of negligence or intentional misconduct. Pictures or Videos will be obtained for medical records. If pictures are used for education and marketing purposes, all identifying marks will be cropped or removed. 

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