Hello Gorgeous Med Spa
74 W. Washington St, Oswego, IL 60543 - (630) 636-6193
VI Peel Informed Consent
Please read this form fully before treatment. Ask questions before signing.
Treatment overview
VI Peel is a medium-depth chemical peel used to improve tone, texture, acne, discoloration, and visible signs of photoaging. The treatment causes controlled exfoliation and peeling. Results vary by skin type, skin condition, home care, and adherence to aftercare instructions.
Possible side effects and risks
- Redness, warmth, tightness, dryness, and visible peeling for several days.
- Temporary stinging, itching, swelling, or acne-like breakouts during healing.
- Uneven pigmentation changes, including temporary darkening or lightening.
- Cold sore flare-up in clients with a history of herpes simplex.
- Infection, prolonged irritation, scarring, or allergic reaction (rare).
Contraindications and precautions
- Pregnant or breastfeeding (unless cleared by your prescribing provider).
- Active skin infection, open wounds, eczema flare, sunburn, or dermatitis in treatment area.
- Recent isotretinoin use, unless provider has determined treatment is appropriate.
- Known allergy or sensitivity to peel ingredients, aspirin/salicylates, phenol, or related compounds.
- Recent waxing, depilatory use, laser treatment, or aggressive exfoliation in treatment area.
Patient acknowledgements
I understand that chemical peel results cannot be guaranteed and may require a series of treatments.
I agree to avoid picking, peeling, or scrubbing treated skin and to follow all post-care instructions including strict SPF use.
I understand that sun exposure, heat, and active skincare products can increase irritation and risk of complications during healing.
I authorize Hello Gorgeous Med Spa clinical staff to perform the VI Peel treatment and related care judged clinically appropriate.
Important:
Contact the office promptly for severe pain, blistering, drainage, fever, or signs of infection after treatment.
Signature
I have read and understand this informed consent. I have had the opportunity to ask questions, and all questions have been answered to my satisfaction. I voluntarily consent to treatment.
Patient name (print)
Date of birth
Patient signature
Date
Provider witness
Treatment area