Free templateChemical peel
Chemical peel consent form
A complete, professional chemical peel consent and medical history form. Free to download and print - or switch it on inside Lumela and it is created for you, live, in about a minute.
Already built for you
Don't start from a blank form
You do not have to recreate any of this. Choose chemical peel when you sign up and this exact form appears in your account, ready to send.
What to check before you treat
These are the answers that change whether the appointment goes ahead. The digital version turns the submission red automatically.
- StopHave you taken isotretinoin (Accutane) in the last 6 months?Skin stays fragile for months after the last dose.
- StopDo you use retinol, tretinoin or another retinoid on this area?Including prescription creams and strong over-the-counter serums.
- StopIs the area sunburnt, waxed or exfoliated in the last 48 hours?
- CheckDo you get cold sores?Work near the lips can trigger an outbreak.
- StopAre you pregnant or breastfeeding?
- CheckDo you have eczema, psoriasis, rosacea or active breakouts on this area?
- CheckDo you have a condition, or take medication, that affects healing or immunity?
- StopHave you had Botox or fillers in this area in the last 2 weeks?
What the form covers
Template wording is a professional starting point, not legal advice. Have your attorney review it for your state.
Paper works. Until it does not.
A printed form has to be filled in at the appointment, filed somewhere, and found again years later. It cannot flag a contraindication, cannot prove when it was signed, and cannot email the aftercare. The same form, sent as a link, does all three.
Get the chemical peel form, free
A complete, printable template written for this treatment. No card, no trial, just the form.
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