Free consent template
A consent form for light professional peels, enzyme peels, and resurfacing treatments. Use it as a starting point — peels carry more risk than a maintenance facial, so adjust the language for your specific products, license scope, and state board guidance.
What this template covers
Copy the text, print directly, or download a .txt file you can edit anywhere.
Preview
Chemical Peel Consent Client name: ______________________________ Appointment date: _________________________ Service: ___________________________________ I understand this treatment may involve exfoliation, tingling, warmth, dryness, flaking, temporary redness, sensitivity, or changes in how my skin feels for several days after the appointment. I agree to share relevant information before treatment, including allergies, recent procedures, prescription skincare, isotretinoin use, pregnancy or nursing status, sun exposure, active irritation, and any medical condition that may affect my skin. I understand that results vary and that a series of treatments and consistent home care may be recommended. I agree to follow all pre-care and aftercare instructions, including sun protection and avoiding exfoliating products until advised. Client signature: __________________________ Provider signature: ________________________ Template note: This is a business template for general education and convenience. It is not legal, medical, financial, or compliance advice. Review and adapt it for your location, license rules, booking platform, and business policies.
Save a customized version with your business name, fees, and contact preferences inside the Esthi toolkit. Free to start — no credit card.
A general facial consent doesn't cover a peel. Get a peel-specific signature at the first peel and ideally at the start of a new series.
Medications, recent procedures, isotretinoin use, and pregnancy or nursing status are the items most often missed on intake. Confirm them verbally before solution touches skin.
If you swap or skip a step because of sensitivity, jot it on the consent or in your booking notes so future appointments have context.
Different states limit peel depth and ingredients estheticians can use. The consent should reflect the products and depth you're actually licensed to perform.
Esthi hub
Cancellation, no-show, refund, consent, and intake templates in one place — with notes on when each one matters and which calculators they pair with.
Open the policies hub →Yes. Peels carry more risk than a maintenance facial — medication interactions, photosensitivity, and a longer recovery window all justify a peel-specific consent rather than a general facial one.
Many providers ask peel clients to re-sign at the start of each peel series or annually for ongoing maintenance peels. Always re-sign when adding stronger ingredients or a deeper resurfacing service.
Most professional guidelines recommend waiting at least 6 months after isotretinoin use before peels or any active resurfacing. Make this an explicit consent disclosure so the conversation happens before the appointment.
Many peel ingredients are contraindicated during pregnancy and nursing. Document the disclosure on consent and postpone the peel if there's any uncertainty.
No. This template is for general business use. It is not medical, legal, or compliance advice. Adjust to your products, state board scope, and have a licensed professional review if you're unsure.