Pro Power Peel Consent Form

Name
MM slash DD slash YYYY
This treatment is designed to resurface the skin. You may experience temporary burning, itching, or stinging. Please inform your professional skin therapist if you experience these sensations.

Your full participation during and after the treatment will determine the outcome. It is important that you strictly adhere to the homecare products and regimen that your professional skin therapist has recommended. It is possible to have a poor reaction or less-than-expected improvement of the skin. No guarantee is made or implied as to the precise results, peeling times or discomfort.

Have you received a cosmetic light-based procedure such as laser treatment, IPL, etc. within the last 6 weeks?
Do you have active cold sores?
Have you received Botox or other injectable procedures within the past week?
Do you sunbathe or use tanning beds?
Do you experience redness, itching, or stinging on your skin?