Prior to receiving treatment, I have been candid in revealing any condition that may have bearing on this procedure such as pregnancy, recent facial surgery, allergies, tendency for cold sores/fever blisters, topical and/or oral prescription medications such as tretinoin, Retin-A, isotretinoin, Accutane, Differin, Tazarac, Avage, Epiduo or Ziana.  

·      I understand there may be some degree of discomfort such as stinging, pin-prickling sensation, heat, or tightness.

·      I understand there are no guarantees as to the results of this treatment due to many variables such as age, condition of skin, sun damage, etc.

·      I understand that I may or may not actually peel and that each case is individual.

·      I understand the amount of peeling does not correlate with degree of improvement.

·      I understand this is a cosmetic treatment and that no medical claims are expressed or implied. I understand that to achieve maximum results, I may need several treatments.

·      I understand that although complications are very rare, sometimes they may occur, and that prompt treatment is necessary. In the event of any complications, I will immediately contact Katherine Booth, who performed the treatment.

·      I agree to refrain from tanning indoors or outdoors while I am undergoing treatment and for 14 days prior or following the chemical peel.

·      I understand that extended direct sun exposure is prohibited while I am undergoing the treatment and that daily use of sunscreen protection with a minimum of 30 is mandatory.

·      I certify that I have not had any chemical peels within 14 days of this treatment and that I cannot have another within 14 days of this treatment.

·      I understand that I should follow my post-care instructions to minimize side effects and maximize results.  

I hereby agree to all the above and agree to have this treatment performed on me. I further agree to follow all post-peel care instructions as directed.