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Mild Peel/Sweet Collection
Are you pregnant/lactating
Skin Type
Skin Concerns
Please select any treatmens you have previously had
Do you currently use/or hve you ever used
Health - please answer yes or no to the below questions
Have you ever had an alergic reaction to any cosmetic product/medicaton/
Please tick any of the below that apply to you
Which fitzpatrick skin type are you?
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Informed Consent for Advanced Treatments:

I acknowledge that no guarantee has been made regarding the results of this procedure. Although it is impossible to list every potential risk and complication, I have been informed of the possible risks and complications which may include, but are not limited to the following:

  • Stinging, itching or irritation

  • Redness and swelling of the skin

  • Tightness, peeling or scabbing of treated skin and surrounding areas

  • Skin sensitivity to wind, sun or other environmental factors

  • Darkened pigmentation

  • Any potential risks and complications could result in the need to discontinue the treatment. In this case, alternative recommendations will be suggested It is very rare that a permanent disability occurs. In case of complication during or after the treatment, I authorise my aesthetician or physician to perform any necessary treatments.

I certify that I am at least eighteen (18) years old.
I confirm I have informed my aesthetician of the following:

  • My diagnosis of diabetes

  • That I am a patient under a physicians care

  • My use of all medications and supplements, including antibiotics

  • My use of Isotretinoin (Accutane) in the past 12 months

  • Any history of radiation to the region

  • Herpes simplex or active infection

  • My history of hypertrophic scar formation

I agree to the following:
• That I am not pregnant or breastfeeding

  • That I have not used Retinoids, Hydroxy Acids or Benzoyl Peroxide for at least one week

  • That I will not use Retinoids, Hydroxy Acids or Benzoyl Peroxide until my skin is healed

  • That I have not waxed in the past week, or shaved the treated area for 24 hours

  • That I will avoid hot baths/showers, sweating and strenuous exercise for one week post procedure

  • That I will avoid rubbing, picking and scrubbing my skin post procedure, as it may result in scarring, hyperpigmentation or other skin damage

  • That I will protect my skin from any sun exposure with a broad spectrum sunscreen of at least SPF 30 daily

  • I have received a patch test prior to my treatment, I have read and will follow any and all instructions to the best of my ability

  • I understand the potential risks and complications, and choose to proceed after careful consideration of the possibility of both known and unknown risks, complications, limitations and alternatives.

Thanks for submitting!

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