Chemical Peel Pre/Post Information

We aim to ensure clients have the best possible advice both prior to and post-treatment.

Children under the age of 16 should have consent from a parent or guardian prior to any appointment.

The following has been taken from the consultation form you will need to sign upon consultation completion. It is published for your information only and should be reviewed prior to making an appointment, to give you a better understanding as to what will be asked of you and to give you an idea of whether or not you are a candidate for this service. Your safety is our top priority.

 

 

1) Do you currently have any of the following?

• Psoriasis

• Eczema

• Dermatitis

• Open Active/Cystic Acne

• Cold Sores/Fever Blisters

• SensitiveEyes

• Hyper Sensitive/Reactive Skin

If yes to any of the above, do not have a peel until any breakout/sensitivity has fully cleared.

2) Do you have any other skin conditions? No    Yes     

If yes, explain:

3) Do you have any allergies? No    Yes

If yes, to what:

4) Have you ever had a reaction to any medication? No     Yes

If yes, to what:

5) Have you ever had a reaction to any cosmetic, hair or salon product? No     Yes

If yes, to what:

6) Are you taking any prescribed medication for acne such as Acutane?  No    Yes

If yes, a 6-month wash out period is required before a treatment can commence.

7) Are you using any topical skin preparations from your doctor?

• Steroid cream

  • Retin-A

  • Topical antibiotic 

  • Other

If yes, please commence treatment 48 hours after your medication course has come to an end.

8) Are you on any prescribed medication?   No     Yes

If yes, please list:

9) Are you taking any supplements? Please list:

10) Are you pregnant or nursing? No    Yes

If yes, no treatment can be performed

11) Have you had any of the following in the last six weeks?

• Laser resurfacing

• Microdermabrasion

• Chemical peels

• Injectables

  • Facial laser hair removal

Ensure skin has normalized before commencing treatment

12) Have you recently been on a sunshine holiday? No     Yes

13) Has your lifestyle changed dramatically recently with any noticeable skin changes? No   Yes

14) Have you had any changes in your beauty routine recently?   No     Yes

Skin Indications for the Peel (Reasons to have the peel)

• Acne

• Acne Scarring

• Hyper-Pigmentation

• Wrinkles/Fine Lines

• Dry/DehydratedSkin

  • Photo Aging

  • Improve Skin Texture 

  • Blocked Pores/Follicles

Any other skin conditions/concerns:_______________________________________________

 

Pre Chemical Peel Contraindications (peel should not be performed)

• Active cold sore

• Inflamed acne cysts

  • Pregnant or nursing

  • Retin-A use

• Radiation/Chemotherapy

• Open wounds

• Allergy to aspirin (Salicylic Acid)

• Sunburn

  • Irritated or damaged skin

15) Have you waxed the area to be treated with a chemical peel in the last 48 hours?  No     Yes

If yes, you must wait until the 48 hours has passed before receiving treatment

Cancellation Policy: Please let us know 24 hours in advance if you need to make any changes to your appointment. Failure to do so may result in a charge equivalent to the value of the appointment.. Clients arriving 15 minutes or later to their appointment may be considered a no-show.