CLIENT DETAILS

Address

MEDICAL HISTORY

Medical History

SKIN CONCERNS & GOALS

Skin Concerns

PRACTITIONER ASSESSMENT

Fitzpatrick Skin Type

Enzyme Peel Information

Enzyme peels use naturally derived enzymes to exfoliate dead skin cells, improve skin texture, brighten skin tone and support skin rejuvenation.

Results vary between individuals and multiple treatments may be required.

EXPECTED RESULTS & LIMITATIONS

Expected Results & Limitations(Required)

Contraindications

  • Active skin infection
  • Open wounds
  • Recent aggressive skin treatment
  • Sunburn
  • Severe rosacea flare
  • Active herpes outbreak
  • Allergy to treatment ingredients

RISKS & POSSIBLE SIDE EFFECTS

Risks & Possible Side Effects Acknowledged(Required)

PHOTOGRAPHY, VIDEO & MARKETING CONSENT

Photography & Marketing Consent(Required)
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PRIVACY POLICY

Privacy Policy Consent(Required)

Clinical records and photographs may be retained according to Australian law and insurer requirements.

FINANCIAL, REFUND & CANCELLATION POLICY

Completed treatments are non-refundable except where required by Australian Consumer Law. Late cancellations and no-shows may result in fees or loss of deposit.

COMPLAINTS POLICY

Complaints Policy Agreement(Required)

This treatment is cosmetic and not intended to diagnose, treat, cure or prevent disease. No verbal or written statement constitutes a guarantee of outcome. Nothing in this agreement excludes rights under Australian Consumer Law. The practitioner reserves the right to refuse or postpone treatment if unsuitable.

PATIENT DECLARATION

Patient Declaration(Required)

TREATMENT RECORD

Aftercare

  • Use SPF50+ daily
  • Avoid sun exposure
  • Avoid retinol, acids and exfoliants for several days
  • Keep skin hydrated
  • Contact the clinic if unusual symptoms occur

FOLLOW-UP REVIEW

SIGNATURES

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