Prior to receiving treatment, I have been candid in revealing any condition that may have bearing on this procedure, such as: pregnancy (please consult with OB/GYN), recent facial surgery, allergies, use of Retin-A, Differin, birth control or hormone replacement. The use of the aforementioned may cause post-inflammatory pigmentation. This condition does not occur due to miracle peeling. If I do use these products or have these conditions, I will refrain from using high strength topical skin products for 3 to 5 days prior and after peeling.

  1. I understand there may be some degree of discomfort; ie. stinging, pinpricking sensations, hotness, or tightness for up to 72 hours.
  2. I understand there are no guarantees as to the results of a 30% AHA/BHA treatment because of outside variables such as: age, skin condition, sun damage, smoking, climate, etc.
  3. I understand I may or may not actually peel, that each case is individual.
  4. I understand this treatment is a cosmetic treatment and that no medical claims are expressed or implied.
  5. I understand that to achieve maximum results, several treatments may be needed.
  6. I understand that although a redness/rash is rare, sometimes it may occur and that I will follow the product protocol advised by my Skin Repair Consultant.
  7. I agree to refrain from tanning in tanning booths while I am undergoing treatment, and during 7 days following the end of treatment.
  8. I understand that direct sun exposure is not recommended while I am undergoing treatment and that the use of sun block protection with a minimum of SPF 15 is understood. Indirect sun exposure is permissible.
  9. I have not had any other peel treatment of any kind within 14 days of the treatment. I understand that I cannot have another treatment within 14 days of this treatment, whether the treatment is performed at this location or any other location.
  10. I understand that if I have been an Accutane patient I cannot receive any peel administered until 12 months after Accutane treatment has ended or prior to 12 months with doctor written permission.
  11. Clients allergic to aspirin must exercise CAUTION with Salicylic in our 30% Glycolic peel. Even though Salicylic is derived from Willowbark, Salicylic does have the potential to turn into aspirin if a large enough quantity enters the bloodstream.

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

Disclaimer - Employees, officers and representatives of Tzone Enterprises Inc. (T4 Skin Care + H Skin Repair) assume no responsibility/liability for consequences/injuries/actions as a result of agreeing to receive a 30% Glycolic or H Amazing 30% Blended Peel or 50/50 Blended Mix. Peeling products are formulated to improve appearance and are in no way intended to diagnose, treat, cure, prevent disease or replace the advice of a qualified medical professional.

Sign and scan consent form to barbara@skinsovibrant.com