Chemical Peel Consent Form
A chemical peel consent form records the client's medical screening, the risks you explained, the aftercare they agreed to and their signature before the peel starts. GlowForms sends it to the client's phone when they book, so it is signed before they arrive.
No credit card required.
Why peels need their own consent form
A general facial consent does not name the risks that come with acids: frosting, days of peeling, and pigment changes that are more likely on deeper skin tones. A peel-specific form shows the client was screened for the conditions that make a peel unsafe and was told what to expect.
If a client reacts, this is the document that shows what you asked, what they disclosed and what they agreed to.
What to screen before a peel
- Isotretinoin (Accutane) in the past 6 months — many protocols postpone peels for this long
- Topical retinoids such as tretinoin, adapalene or retinol in the past week
- Pregnancy or breastfeeding
- Active cold sores, or a history of them
- Sunburn, recent tanning or a planned beach holiday
- Waxing, laser, injectables or another peel in the treatment area recently
- Allergies, including aspirin (relevant to salicylic acid)
- Skin type — the Fitzpatrick versions of this template add a structured assessment
Reactions to explain before treatment
- Redness, tightness and stinging during and after the peel
- Flaking or visible peeling for several days
- Temporary darkening of the skin before it sheds
- Less common: prolonged redness, hyper- or hypopigmentation, a cold-sore flare, and rarely scarring
Aftercare the client acknowledges
- Daily broad-spectrum SPF and sun avoidance
- No picking or pulling peeling skin
- No exfoliants, retinoids or other active products until you say so
- Contact you if redness, swelling or blistering gets worse instead of better
Chemical Peel templates in GlowForms
Pick the version that matches how you work, then add your logo and your own questions.
- • Chemical Peel - Intake & Consent
- • Chemical Peel - With Fitzpatrick Assessment
- • Chemical Peel - With Fitzpatrick & Cancellation Policy
- • Chemical Peel - With Fitzpatrick + Photo & Video Release
- • Chemical Peel - With Fitzpatrick, Cancellation + Photo & Video Release
- • Chemical Peel - With Cancellation Policy
- • Chemical Peel - With Photo & Video Release
- • Chemical Peel - With Cancellation + Photo & Video Release
- • Chemical Peel - Care Advice (aftercare sheet you send after the visit)
How it works
- Attach the form to your chemical peel service.
- When a client books, they get the form by email and complete it on their phone.
- You see their answers and signature before the appointment, and they stay in the client record.
FAQ
Do I need a new consent form for every chemical peel?
One signed form per peel type is common practice. Have the client sign again when the peel strength changes, or when their health, medications or skincare routine changes.
How long before a peel should a client stop retinoids?
Follow the peel manufacturer's protocol and the client's prescriber. The consent form records what the client told you so you can decide whether to go ahead, adjust or reschedule.
Can a client under 18 get a chemical peel?
Only with a parent or guardian's signature and within your state's rules. GlowForms forms can collect a guardian signature.
Are digital signatures valid on a peel consent form?
In the US, the federal ESIGN Act and state electronic-transaction laws give electronic signatures the same legal effect as handwritten ones for most agreements. Ask your insurer if they have specific requirements.
General information, not legal or medical advice. Adapt every form to your state's rules, your insurer's requirements and the product manufacturer's protocol.