Spa Advanced Treatment Consent Log

Captures informed consent for chemical peels and other advanced esthetic treatments, including contraindication screening and treatment acknowledgment.

Client and Visit Details

• Client name
• Service date
• Provider name
• Treatment type
• If other, describe the treatment

Consent and Disclosure

• The treatment, expected benefits, and common risks were explained to me in language I understand.
• I received aftercare instructions and understand that following them is important for safe healing.
• I consent to receive the selected treatment today.
• I had the opportunity to ask questions and received satisfactory answers.
• Client signature

Contraindication Screening

• Are you pregnant or nursing?
• Have you used isotretinoin (Accutane) in the past 6 months?
• Have you had a peel, laser, waxing, or other exfoliating treatment in the last 14 days?
• Do you currently have any of the following in the treatment area?
• If you selected any condition other than 'None of the above', describe the area and concern

Medical and Sensitivity History

• Do you have any allergies or sensitivities relevant to skincare products or acids?
• If yes or unsure, describe the allergy or sensitivity
• Have there been any recent medication changes that may affect skin sensitivity?
• If yes or unsure, describe the medication change

Provider Review and Outcome

• Screening result
• Provider notes or rationale