Skip to content
REFRESHING FACIALS
HEALING PEELS
WHOLE BODY SKIN CARE
HAIR REMOVAL
EDUCATIONAL TOOLS
Microcurrent Success Tip Sheet
The 5 Best and 5 Worst Topical Ingredients for Anti-aging
REFRESHING FACIALS
HEALING PEELS
WHOLE BODY SKIN CARE
HAIR REMOVAL
EDUCATIONAL TOOLS
Microcurrent Success Tip Sheet
The 5 Best and 5 Worst Topical Ingredients for Anti-aging
Book Now
Skin Care Services
REFRESHING FACIALS
HEALING PEELS
HAIR REMOVAL
WHOLE BODY SKIN CARE
Skin Care Knowledge
FAT CAVITATION PRE & POST CARE
AFTER SKIN CARE TREATMENT F.A.Q.
BEAUTIFUL SKIN PROTOCOL
CLIENT FORMS
BOOK NOW
ABOUT SKIN SHAMAN STUDIO
CONTACT
Skin Care Services
REFRESHING FACIALS
HEALING PEELS
HAIR REMOVAL
WHOLE BODY SKIN CARE
Skin Care Knowledge
FAT CAVITATION PRE & POST CARE
AFTER SKIN CARE TREATMENT F.A.Q.
BEAUTIFUL SKIN PROTOCOL
CLIENT FORMS
BOOK NOW
ABOUT SKIN SHAMAN STUDIO
CONTACT
Chemical Treatment Consent Form
Save some time before your skincare appointment. All your information is secure and we will never sell or share it with any 3rd parties. Read our privacy policy for more information.
Read this consent form thoroughly and check the circle of each section. Discuss any questions with your skin care professional before you initial. Your signature and date at the bottom constitute giving your consent to have a treatment.
I understand that there are no guaranteed results from this treatment. Many variables exist such as age, degree of sun damage, on going sun exposure, smoking, excessive alcohol intake, climate, diet, water intake, skin thickness and sensitivity. I understand that I may or may not visibly peel and that each case is individual.
I have been candid in revealing any condition that could prohibit this treatment such as cold sores, pregnancy, and use of hormones (birth control and HRT), recent facial surgery or laser resurfacing, recent use of retinol, within the past 5 days, or Accutane within the past 6 months. Any immune system diseases including but not limited to Lupus, HIV, Hailey Hailey, or any and all autoimmune diseases.
Regardless of precautions taken, I acknowledge the possibility of an adverse reaction to the peel and accept sole responsibility for any medical care that may become necessary. I will immediately notify the esthetician performing the treatment of any adverse reactions.
I will not scratch, pick, or scratch the treated skin.
I understand that direct sun exposure and use of a tanning booth is prohibited during a post treatment of 14 days and that there is a mandatory use of a (minimum SPF 15) mineral sunscreen protection daily to be reapplied every 3 to 4 hours or as directed by the esthetician.
I understand that to achieve maximum results the recommended home care routine must be followed. I understand that if I alter the routine or use products not recommended by the esthetician the results could be altered or inhibited. I also understand that it may take several treatments to obtain the desired results.
I understand that the following side effects or complications can occur:
Redness
Discomfort
Redness and swelling
Hypopigmentation
Itching or irritation
Skin peeling or flaking up to 14 days after the procedure
Infection
Hyperpigmentation
Acne breakouts
I understand the goals of the treatment as well as well as the limitations and possible complications.
The esthetician has provided the information and has ansered all of my questions concerning this procedure. I clearly understand the above information.
By checking this box you agree to the terms of the Chemical Treatment Consent Form
Name
Date
MM slash DD slash YYYY
Scroll to Top
