Clinical Consent

Chemical Peel Patient Information and Informed Consent

This form supports — but does not replace — the consultation and clinical assessment. It explains the proposed treatment, realistic benefits, alternatives, material risks and aftercare. Please read it carefully and ask about anything you do not understand. Signing does not remove your legal rights and does not oblige the practitioner to treat if it is not clinically appropriate.

    • I understand that a chemical peel is a cosmetic procedure that involves the application of a peeling solution to the skin to improve its appearance. The treatment may help reduce the appearance of fine lines, acne, pigmentation, uneven skin tone, and other skin concerns.

    • I understand that results vary between individuals and that multiple treatments may be required to achieve the desired outcome.

  • I acknowledge that I have been informed of the possible side effects and risks associated with chemical peel treatments, including but not limited to:

    • Redness

    • Dryness and tightness

    • Peeling and flaking of the skin

    • Swelling

    • Sensitivity to sunlight

    • Temporary changes in skin pigmentation

    • Acne breakouts or milia

    • Infection (rare)

    • Scarring (rare)

    • Allergic reaction (rare)

    • Delayed healing

    I understand that unforeseen complications may occur despite proper care and treatment.

  • I confirm that:

    • I have provided accurate and complete medical information.

    • I will follow all pre-treatment and aftercare instructions provided.

    • I understand the importance of using sunscreen following treatment.

    • I will avoid picking or peeling the treated skin.

    • I understand that failure to follow aftercare advice may affect my results and increase the risk of complications.

Please complete the form below as fully as possible. This information will be used to ensure you receive the best possible treatments from us. If you have any questions, please do not hesitate to contact us.