» Acne Treatment & Chemical Peel Form

Acne Treatment / Chemical Peel

CLIENT INTAKE FORM

Select Treatment Type

Client Information

Treatment Description

Acne Treatment: May involve cleansing, exfoliation, extraction, LED light, and spot treatment serums to reduce acne and inflammation.

Chemical Peel: Uses professional-grade exfoliating acids to improve skin texture, treat acne scars, reduce pigmentation and boost radiance. Peel depth varies per skin condition.

Extraction Notice:

Manual extraction involves applying pressure to the skin to remove impurities and acne. Temporary redness or swelling may occur after treatment — this is a normal skin reaction.

Clients are advised to avoid makeup, events, or exposure to pollution after the procedure.

Please read carefully before proceeding with the acne treatment. By signing below, you acknowledge and accept the possible side effects.

Medical History

Do you currently have or have had any of the following?

Risks & Side Effects

  • Redness, irritation, flaking or peeling
  • Sensitivity to sun and skincare products
  • Possible pigmentation changes or acne flare-ups
  • Risk of allergic reactions or prolonged healing if aftercare is not followed

Client Responsibilities & Aftercare

  • Avoid sun exposure and always use sunscreen
  • Do not pick or exfoliate the treated skin
  • Use recommended products only
  • Avoid sweating, saunas, or hot showers for 24-48 hours

Photo/Media Consent

I give TR BEAUTY SPA permission to take photos/videos of my treatment area for:

Consent & Release

  • I confirm all provided information is accurate.
  • I understand the nature, risks, and expected outcomes of the treatment selected.
  • I release TR BEAUTY SPA and its staff from liability for any reactions or results due to undisclosed conditions or failure to follow aftercare.
  • I understand results vary and multiple sessions may be required.

By signing below, I confirm that I have read and understood the information provided, and I willingly consent to undergo the specified acne treatment at TR.beautyspa.

Client Signature

Please sign in the box below

Treatment Session Log

Please fill in the following table with the date and notes for each session.

Session Date Notes
Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Session 8
Session 9
Session 10
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