Skin Peel Consultation Form

Your Health

Your Skin

Female Clients Only

Male Clients Only

CANCELLATION POLICY: Please give 24 hours’ notice if you are unable to attend an appointment.

Privacy Statement

We take your privacy seriously. We will only use your information to provide services that you have requested and give you information regarding treatments and products available here at the clinic. Any medical information we hold will only be used by our company staff in connection with your appointment and will be stored securely. We are required by law (and our insurers) to keep your personal and medical details for a minimum of 7 years, after which time it will be securely destroyed. Your information will never be passed on to a third party unless we are legally obliged to do so.

From time to time we would like to contact you via email, text or post. These communications will include our regular newsletter, details of offers and events, and occasionally free samples. We will also continue to offer text appointment reminders.

YOUR RIGHTS: If at any point you believe the information we hold is incorrect you may request to see this information, and have it corrected or deleted.

For further information regarding our privacy policy, please see our website.

Chemical Peel Pre-Treatment Advice 

To maximize the desired outcome of the chemical peel, Skin restoration recommends you follow these pre-treatment instructions prior to your scheduled treatment:

1. If you are using a retinoid product (Retin A, Tri Retinol Complex, vitamin A etc) you must STOP 5 days prior to the chemical peel.

2. Use a physical sunscreen with at least an SPF 30+ every day rain or shine for at least 1 week prior to the chemical peel.

3. STOP the use of any benzoyl peroxide product (Purity Gel Spot TX, Acne Lotion, etc.) or any other product that can cause dryness, redness or irritation 3 days prior to the chemical peel.

4. If prone to cold sores, a physician-dispensed prescription must be used 2 days before and 5 days after the chemical peel.

5. Avoid using clay masks, scrubs or additional exfoliating agents for at least 48 hours prior to each procedure.

6. Do not use self-tanning agents for at least 48 hours prior to each procedure.

In Addition:

No facial waxing 1 week prior to chemical peel
No filler 1 week prior to chemical peel
No IPL or Laser Hair Removal 2 weeks prior to chemical peel
Botox can be done up to 1 day before a chemical peel

If you have any concerns please contact your practitioner.

Covid-19 Guidance