TemplatesChemical peel
chemical peel consent form
A peel is a controlled chemical injury.
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- screening questions
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Chemical peel consent
Full name
Date of birth
Email
Phone
Have you taken isotretinoin (Accutane) in the last 6 months?
YesNo
Isotretinoin
Why this form, specifically
It asks about photosensitising medication and Fitzpatrick type the two missing fields behind most peel pigmentation claims - and records the acid, layers and contact time your insurer will ask for.
Look before you download
The whole document, before you give us anything
Chemical peel consent
Your details
Full name
Date of birth
This is where your aftercare instructions go.
Phone
Health questions
Have you taken isotretinoin (Accutane) in the last 6 months?
Skin stays fragile for months after the last dose.
Do you use retinol, tretinoin or another retinoid on this area?
Including prescription creams and strong over-the-counter serums.
Is the area sunburnt, waxed or exfoliated in the last 48 hours?
This is the form you get
Not a sample, not a preview of a preview. Every question below is in your account ten minutes after you sign up, with the flags already set and the aftercare email already written.
- 14-day trial
- No card needed
- Set up in 10 minutes
- Cancel anytime
The 8 answers that should stop you
A peel is a controlled chemical injury. The screening is not a formality - it is the entire difference between a controlled injury and an uncontrolled one, and every question below is asking whether this particular skin will heal the way you are expecting it to.
Do not treat
5WhyImpaired re-epithelialisation. The skin cannot close a wound at its usual speed, and a peel is a wound.
What goes wrong if you treat anywayProlonged healing, hypertrophic scarring and hyperpigmentation.
What to doSix months minimum after the last dose, and start at a lower strength than you otherwise would.
The question that catches itHave you taken isotretinoin (Accutane) in the last 6 months?
WhySalicylic acid is systemically absorbed and avoided in pregnancy, and pregnancy skin is strongly predisposed to melasma.
What goes wrong if you treat anywayAn ingredient the client would not have chosen, and pigmentation that can persist for years.
What to doPostpone anything beyond a superficial lactic or mandelic peel until after breastfeeding.
The question that catches itAre you pregnant or breastfeeding?
WhyOpen injection channels plus an acid is an infection route, and heat can move unsettled product.
What goes wrong if you treat anywayInfection at the sites, and migration of filler.
What to doFourteen days, and confirm the actual date.
The question that catches itHave you had Botox or fillers in this area in the last 2 weeks?
WhyDoxycycline, some diuretics and several other common drugs amplify UV response. A peel plus photosensitivity is a pigmentation event waiting to happen.
What goes wrong if you treat anywayPost-inflammatory hyperpigmentation, which on Fitzpatrick IV to VI can take a year to fade.
What to doPostpone, or reduce depth substantially and insist on strict sun avoidance and daily SPF 50.
The question that catches itDo you take any medication that makes you sensitive to sunlight?
WhyAcid on broken skin penetrates unpredictably and much deeper than intended.
What goes wrong if you treat anywayA chemical burn rather than a peel, because the acid reaches tissue that was never meant to be exposed to it, and a scar where the client expected an improvement.
What to doAn absolute no until the skin is fully intact and no longer peeling. Reschedule rather than working around the area - acid migrates, and a margin you can see is not a margin the acid respects.
The question that catches itIs the area sunburnt, waxed or exfoliated in the last 48 hours?
Proceed with caution
3WhyPeels are one of the most reliable triggers for reactivating herpes simplex, particularly around the perioral area.
What goes wrong if you treat anywayA widespread outbreak over freshly peeled skin, which can scar.
What to doFor any medium-depth peel, prophylactic antiviral cover arranged with their doctor is standard practice. Ask, and document the answer.
The question that catches itDo you get cold sores?
WhyAny controlled wound in a keloid-former can produce an uncontrolled scar response.
What goes wrong if you treat anywayA raised, permanent scar in place of the improvement they came for.
What to doSuperficial peels only, test patch first, and be honest that this may not be the right treatment for their skin.
The question that catches itDo you scar badly, or get keloids?
WhyMelanocytes in deeper phototypes respond to inflammation by producing more pigment, not less.
What goes wrong if you treat anywayThe peel worsens exactly the pigmentation it was booked to improve.
What to doPre-treat with a tyrosinase inhibitor, go shallower than you think, and test patch. Set expectations across a course, not one appointment.
The question that catches itDo you have melasma or any pigmentation concern?
What you actually get
Nobody buys a consent form
They buy the fifteen minutes back at the start of an appointment. They buy the phone call they did not have to make, because the contraindication turned up two days early instead of two minutes late. They buy an insurer who pays out, because the patch test has a timestamp rather than a memory attached to it.
The form is the mechanism. What you are actually buying is the record it leaves behind.
That is the whole argument, and it is why the questions matter more than the software. A blank form builder hands you a canvas and calls it flexibility. This hands you the nine questions that a waxing client should be asked, in the wording that gets an honest answer, with the risky one already flagged in red.
What this saves you
Not what the form contains - what it gives you back. Every number below is arithmetic you can check on the calculator further down the page.
Before they sit down
not halfway through
A form that collects answers and does nothing with them has solved the wrong problem. A risky answer turns the submission red and names the reason at the top, at the only moment the information is worth anything.
12 hours
a year, back in your chair
A new client filling in a paper form in your treatment room costs ten to fifteen minutes of an appointment they already paid for. Send it with the booking confirmation and that time goes back into treating, at roughly twelve hours a year on twenty clients a week.
A defensible claim
instead of a disputed memory
Most professional policies in these trades condition cover on documented screening, and a patch test you can describe is not a patch test you can produce. A timestamped record is the difference between a claim your insurer defends and one they decline.
4 seconds
from signature to aftercare email
The aftercare for their treatment lands in their inbox before they have left the chair, written for that service and editable in your words. Clients who follow aftercare heal better, complain less and rebook more - and you did nothing.
Same week. One thing changed.
The left-hand column is most studios today. The right-hand one is the same week with the form sent at booking instead of handed over on arrival.
- She arrives, you hand her a clipboard, she fills it in while you wait
- Halfway through she mentions the retinol she uses nightly
- You improvise a gentler treatment and hope
- The form goes in a folder you will never open again
Nothing here is negligent. It is just undocumented.
- The form was done at home, the evening she booked
- You saw the retinol answer flagged in red two days ago
- You rescheduled by message, before either of you lost the slot
- It is on her record, searchable, next time she books
Same treatments, same clients, same you. Different record.
Contraindication checker
Can you treat a client who...?
Pick a treatment and a condition. The answer comes with the reason behind it, and the form question that catches it.
Pick a condition
Every answer here is the same rule set that ships inside the product's forms.
A peel is a controlled chemical injury. Screening is not a formality here - it is the whole difference between a controlled injury and an uncontrolled one.
Chemical peel
What goes wrong without it
It is July, the client is on doxycycline for acne, and she has Fitzpatrick IV skin.
She has a 30% glycolic peel, which is unremarkable in itself. Nobody asks about medication because the form has a line for 'allergies' and not one for 'photosensitising medication', and she does not think of an acne antibiotic as relevant to a skin treatment. She drives home with the sun on the left side of her face. Six weeks later the pigmentation is worse than the acne she came in for, it is asymmetric, and it takes eleven months and a course of pigment-inhibiting treatment to resolve. Two missing form fields - medication and Fitzpatrick type.
What a chemical peels consent form has to cover
The actual field list, and why each group is on this particular form.
Identity and skin typing
- Full name
- Date of birth
- Phone
- Fitzpatrick type
- Ethnic background
Fitzpatrick type is a required field on this form and an optional one on most others. It changes the peel you choose, the strength and the pre-treatment - and getting it wrong on deeper phototypes produces pigmentation that lasts a year.
Absolute contraindications
- Pregnant or breastfeeding
- Isotretinoin in the last 6 months
- Photosensitising medication
- Broken skin, sunburn or active infection
- Recent injectables
Doxycycline is the one that gets missed. It is a common acne medication, so the client on it is exactly the client booking a peel.
Caution screening
- Cold sore history
- Keloid or hypertrophic scarring
- Melasma or pigmentation history
- Recent sun exposure or tanning
- Previous peel reactions
- Home actives and prescription retinoids
The cold sore question is here rather than in the stops because it is manageable with prophylaxis - but only if you ask far enough in advance for the client to arrange it.
Peel record
- Acid and percentage
- pH and layers applied
- Contact time
- Neutralised at
- Observed frost or erythema
The peel record is the professional part of the document. If a client's outcome is ever questioned, contact time and layers are the facts that answer it.
Aftercare and consent
- Downtime and peeling expectation
- Strict sun avoidance commitment
- No picking acknowledgement
- Consent statement and initials
- Photo permission
- Signature with timestamp
The no-picking line prevents the scarring that produces the complaint. Clients pick, and a signed acknowledgement changes the conversation afterwards.
Is a digital signature legally valid?
Exact time signed
IP address
Device and browser
The exact form they saw
Yes - the US ESIGN Act and the state UETA adoptions give it the same legal effect as ink. What makes it hold up is the evidence stored beside it, and a paper form in a drawer carries none of this.
Sign with your fingerDraw a signature with your mouse or trackpad
Where you stand legally
Peel depth is where esthetician scope of practice is drawn in most US states, and the boundary is usually described in terms of what layer the acid reaches rather than what the bottle says. Superficial peels are almost universally within scope; medium-depth peels frequently are not, and deep peels essentially never are. Complicating this, the same acid at different percentages, pH values and contact times produces different depths, so the product label alone does not answer the question. What protects you is the record: acid, percentage, pH, layers, contact time and neutralisation, per appointment. That record is also what your insurer will ask for. A second issue specific to peels is the pre-treatment obligation on deeper phototypes - failing to pre-treat Fitzpatrick IV to VI skin before a peel that is likely to inflame it is the kind of omission that reads as a standard-of-care failure rather than bad luck. Check your board's specific depth language. Not legal advice.
Paper, PDF or digital?
Paper
Fine when you are small
- Signed before they arrive
- Flags contraindications
- Findable by name in seconds
- Proves when it was signed
- Sends aftercare automatically
- Costs nothing
Emailed PDF
Worst of both
- Signed before they arrive
- Flags contraindications
- Findable by name in seconds
- Proves when it was signed
- Sends aftercare automatically
- Costs nothing
Digital
Earns its place at scale
- Signed before they arrive
- Flags contraindications
- Findable by name in seconds
- Proves when it was signed
- Sends aftercare automatically
- Costs nothing
Three clients a week? Print it and staple it in a binder. That is genuinely fine, and software would be an expense with no return. Digital earns its place around ten to fifteen clients a week, when finding one form again matters more than the minutes it took to file it.
Questions people actually ask
Not beyond a superficial lactic or mandelic peel, and many practitioners postpone entirely. Salicylic acid is systemically absorbed and avoided in pregnancy, and pregnancy skin is strongly predisposed to melasma - so the treatment can worsen exactly what it was booked to improve.
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General guidance for professionals, not legal or medical advice. Check the rules that apply where you work.