Prior to receiving treatment, I have been candid in revealing any condition that may have bearing on this prcedure, such as: Pregnancy, recent facial surgery, allergies, tendency to cold sores, fever blisters, use of Retina-A, Accutane, hormones, or Cellex-C.

  • I understand this treatment is a cosmetic treatment and that no medical claims are expressed or implied.
  • I understand there can be some streaks which will disappear in a few days and a slight burning sensation.
  • I understand that although complications are very rare, sometimes they may occur and that prompt treatment is necessary. In the event of any complication, I will immediately contact the esthetician or technician who performed the treatment.

I have not had any other peel treatment of any kind within 14 days of the treatment.

I hereby agree to all of the above and agree to have this treatme3nt performed on me. I further agree to follow all post-peel care instructions as I am directed.