11550 Jonesbridge Rd, Suite# 6, Alpharetta GA 30022
Email: info@cosmomedspaatl.com         Tel: (678) 829-7722

Chemical Peels Consent Form



Pre and Post Treatment for Chemical Peels

  • Do not use prescriptive topical, abrasive scrubs or strong exfoliants 3-5 days pre and post treatment. (Retin-A, retinols, glycolic acid, salicylic acid)
  • No prolonged sun exposure 1 week prior and 2 weeks post treatment
  • I am currently NOT taking or using any medications that are contradicted to receiving chemical peel. (Accutane, antibiotics)

Informed Consent

Superficial chemical peels are topical exfoliants applied to the skin to soften the dead skin layer and exfoliate the skin. Stimulating cell turnover will help to restore the skin to a more youthful appearance. Many skin conditions can be improved when receiving a series of peels. Fine lines will be softened, dull skin will appear more radiant, rough or uneven skin will become smoother. Sun damaged skin or blotchy skin will even out. Acne scarring may be softened.

I understand that any time the skin barrier is compromised, there is a small risk of infection. I will contact my skin specialist or aesthetician immediately should this happen.

I understand that following the treatment my skin may appear red and feel like it has a slight sunburn.

Possible side effects include but are not limited to: slight or extreme redness, swelling, stinging, itching, tenderness, dry or flaking skin. I UNDERSTAND THAT I AM NOT TO PICK OR PULL THE FLAKING SKIN AS THIS COULD CAUSE UNWANTED PIGMENTATION OR SCARRING. Most side effects will gradually diminish over time as healing may take several days or longer.

The chemical peel treatment has been fully explained and any questions or concerns that I have, have been addressed.

I acknowledge that no guarantee has been given to me as to the condition of the complexion, skin pore size, wrinkles or the percentage of improvement expected following treatment, due to each individual’s unique reactions.

I understand that no specific results are guaranteed.

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ THAT ABOVE INFORMATION AND THEREBY CONSENT AND AGREE TO THE TREATMENT WITH ITS ASSOCIATED RISK. I HEREBY CONSENT TO RECEIVE A CHEMICAL PEEL.