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.

I 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

Precisely buffered and pH stable, our Pharmaceutical Grade 30% Blended Glycolic Peel or 30% H Amazing Blended Peel safely yet effectively addresses skincare conditions such as: brown spots + brown patches, uneven skin texture, aging, sun damage and blemish prone skin, delivering outstanding visible results.

Ideal for all skin types; oily or blemish prone, aging and mature or sun damaged. These all natural AHA/BHA miracle peel treatments dissolve the intra-cellular ‘glue’ bonding cells that prevent proper exfoliation. They deliver dramatic results, even more remarkable on severely sun damaged and blemish prone skin. Our all natural pharmaceutical grade alpha/beta hydroxy face peels will effectively help to reduce the depth of surface lines, smooth out rough skin texture; help fade brown spots and assist in drying out acne/blemished skin. A build-up of dead skin surface cells prevents home care products from penetrating. Our alpha/beta hydroxy peels remove this surface build-up, hydrating the skin and giving it a plumper, “thicker” appearance. Rosacea/Red Skin conditions also improve with alpha/beta hydroxy face treatments as redness and inflammation subside substantially after the treatment. The end result of an alpha/beta hydroxy all natural peel is an immediate tightening and brightening of the skin.

TREATMENT PROTOCOL

STEP 1

*Begin with skin that has been thoroughly cleansed of makeup, oil and debris. Do not place any moisturizers on the skin prior to a peel as this prevents the peel from effectively penetrating.

STEP 2
Alpha/Beta Hydroxy Peel

*Using a small fan brush or finger tips, apply a thin coat of alpha/beta hydroxy peel to the face avoiding the under and upper eye area. You may brush or apply to crow’s feet but do not place peel on the delicate eye area. Leave on skin for up to 15 minutes depending on the resiliency of the skin.

STEP 3

*Rinse peel thoroughly using a cotton pad, sponge, or soft face cloth with cool water.
*Apply a moisturizer and sunscreen.

Precautionary Notes

*Do not use if pregnant or lactating
*Retin-A/Renova or Differin use and Microdermabrasion should be stopped 3 to 5 days prior to a peel and 3 to 5 days post treatment.
*Do not have electrolysis, collagen injections, Botox, facial waxing or use depilatories for approximately 5 days before or after a treatment.

1. If you have been an Accutane patient you cannot receive any peel administered until 12 months after Accutane treatment has ended or prior to 12 months with doctor written permission.
2. 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.

Disclaimer: Employees, Officers + Representatives of Tzone Enterprises Inc (T4+ H Skin Repair) assume no responsibility/liability for consequences/injuries/actions as a result of agreeing to receive a 30% Blended Glycolic, 30% Amazing Blended or 50/50 mix of any of the aforementioned peels. Alpha/Beta Hydroxy 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.