DuVall's School of Cosmetology

Chemical Peel Consent Form 


In the field of skincare, we define the process of removing excess accumulations of dead cells from the skin as peeling or exfoliation. This can be done by using products (Glycolic acid etc.) formulated to achieve specific results known as chemical peels. The process involves an application to the skin in an area with a cotton swab or small brush. The chemical is left on the skin for a certain period of time depending on the solution, product strength, skin type, skin condition, sensitivity, age, or prior use of any exfoliating agent to obtain a specific result. The rate of improvement depends on age, skin type, condition, degree of the sun or environmental damage, pigmentation levels, as well level of peel being used. To achieve maximum results it is recommended to do a series of treatments.

Potential Benefits

I acknowledge that no guarantee has been made about the results of the procedure. Some areas of improvement that may be achieved are as follows: 

  • Softer smoother skin 
  • Reduction in the appearance of lines and wrinkles 
  • Reduction in acne lesions 
  • Reduction in the appearance of sun or age spots 

Potential Risk 

Although it is not possible to list every potential risk and complication, I agree I have been informed of some possible risks and complications which may include but are not limited to the following: 

  • Swelling and redness 
  • Scabbing or peeling of treated skin and surrounding areas 
  • Prolonged skin sensitivity 
  • Areas of increased or decreased pigmentation 
  • Burning of the skin 

Any potential risk and complications could result in the need to discontinue the treatment. 

 

By signing below I authorize DuVall's School of Cosmetology to perform the following peel. 

While some peels are neutralized and removed during treatment, I understand that TCA and Jester's peels are applied in layers and are not fully removed.

 



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Signature Certificate
Document name: Chemical Peel Consent Form 
lock iconUnique Document ID: ea3faa7e7ce9d35f3d676e1d9e7b5a1adb4547d1
Timestamp Audit
July 30, 2021 12:12 am CDTChemical Peel Consent Form  Uploaded by DuVall Adminitrative Staff - [email protected] IP 47.24.68.104