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Chemical Peel Consent Form

A chemical peel consent template — capture informed consent before a peel, checking retinoid use, sun exposure and contraindications.

Description

A chemical peel is effective but needs the skin prepped and the client informed, so consent isn’t a formality. This chemical peel consent form records the client’s consent and screens for the things that make a peel unsafe on the day.

It captures the client’s name and date of treatment, whether they’ve used retinoids in the last week, and any recent sun exposure, sunbeds or fake tan. It checks whether listed conditions apply, sets out the risks and aftercare, and takes their consent and signature.

Use it before every peel, screening on the day for retinoids and sun exposure. A signed, dated consent shows the client was informed and suitable. Customize the risks and aftercare to fit your peels, add your branding, and embed it on your site or share a link in minutes.

Form fields

Everything the Chemical Peel Consent Form above collects — 12 fields across 2 pages, so you can see exactly what it captures before you make it your own.

Chemical Peel Consent

  • Full name

    Name Icon
    Name

  • Date of treatment

    Date Icon
    Date

  • Have you used retinoids in the last 7 days?

    Yes/No Icon
    Yes/No

  • Any recent sun exposure, sunbeds or fake tan?

    Yes/No Icon
    Yes/No

  • Do any of these apply?

    Multi-Select Icon
    Multi-Select

  • Please detail anything ticked above

    Long Answer Icon
    Long Answer

Consent & aftercare

  • Risks

    Consent Icon
    Consent

  • Aftercare

    Consent Icon
    Consent

  • Consent

    Consent Icon
    Consent

  • Signature

    Signature Icon
    Signature

  • Email address

    Email Icon
    Email

  • Contact number

    Telephone Icon
    Telephone
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Template FAQs

Common questions about the Chemical Peel Consent Form — what it captures, when to use it, and how to make it your own.

What is a chemical peel consent form?

A chemical peel consent form records that a client agreed to a peel after being informed of the risks and aftercare, and screens for anything that makes it unsafe. It protects both the client and the therapist before treatment goes ahead.

What should a chemical peel consent form include?

This form captures the client’s name and date of treatment, whether they’ve used retinoids in the last seven days, any recent sun exposure, sunbeds or fake tan, whether listed conditions apply, the risks and aftercare, and their consent and signature.

When should a client sign a chemical peel consent?

Before the peel, on the day, with the retinoid and sun-exposure checks done then — because both change close to the appointment. Signing beforehand confirms the client is informed and suitable at the moment of treatment, not days earlier.

Who needs to sign a chemical peel consent form?

Every client having a peel. The form captures their signature and screens for retinoids, recent sun and contraindications, so the therapist knows the skin is safe to peel and has a record that the client understood and consented.

Why ask about retinoids and sun exposure before a peel?

Because both make skin more sensitive and raise the risk of a burn or reaction from a peel. Checking for recent retinoid use, sunbeds, sun or fake tan on the day lets the therapist adjust the peel or postpone it, keeping the treatment safe.

Is this chemical peel consent template free?

Yes, completely free. Adjust the risks, aftercare and screening to match your peels and protocols, and restyle it to your brand, then embed it on your site or share a link — no coding needed. A free Fun Forms account lets you collect signed consent.

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