ProPeel Informed Consent Form

To the client: You have the right to be informed about your skin condition and treatment, so that you may make the decision whether or not to undergo the procedure after knowing the risks and hazards involved.. This disclosure is not meant to scare or alarm you; it is simply an effort to better inform you so that you may give or withhold your consent_ for the treatment program. 


The ProPeel® is a light chemical peel consisting of trichloroacetic acid, salicylic acid, and alpha hydroxyacids (fruit acids), This Peel stimulates new skin cells, new collagen and increases the blood flow to the skin. It does not replace deep chemical peels, dermabrasion, laser resurfacing and/or plastic surgery.

My interest in the Peel is primarily for :
My areas of concern are the :

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