Consent Form


I DECLARE Sydney Dermal Lounge has explained to me, the convenience of undergoing peeling treatment sessions.

  1. The purpose of this technique is to remove the most superficial layers of the skin in order to stimulate the cell renovation and as a final result, to obtain an even cutaneous tone and a renovation of the skin.
  2. The treatment consists in the elimination of the outmost layers of the skin by the application of chemical agents, by creating a light burn and its consequent re epithelisation. Different acids can be used such as hydroxy acids, resorcin, jessner solution and salicylic acid. The technique is indicated for superficial scars, hyperpigmentation, wrinkles and any other disorders affecting the epidermis.
  3. It has been explained to me by the physician, that in order to obtain best results, I need to strictly follow the treatment in the clinic and the post peel treatment at home. It is recommended to pre treat the skin with daily use of glycorepair cream. For best results, I need to complete a course of six treatments, one every 15 days.
  4. I understand that whilst this is a suitable treatment for my skin, some side effects can appear such as pain, itching, scalping, superficial desquamation, erythema, acne outbreaks, hyper or hypopigmentation of the treated areas.
    The doctor has ordered not to expose the treated area to direct sun after the sessions and explained the importance of the use of hydrating moisturiser with sun protection and home maintenance cream after the treatment. I have been informed that the final result also depends on the home maintenance treatment, recommending the application of Post Procedure Fast Skin Repair as often as necessary. This is to restore and repair the hydrolipidic film of the skin immediately after the session. My protocol is the daily application of post procedure fast skin repair and hydrating moisturiser with sun protection for the first week after the peel, the second week I can resume the nightly application of glycorepair and use of post procedure fast skin repair every morning. I understand the importance of continuing the use of sun protection.


My clinical findings are important to determine the success of the treatment; so it is imperative to check:

  • Allergies
  • Medication
  • History of herpes simplex virus infection.
  • Family or personal history of keloids or other circumstances
  • Pregnancy / Breastfeeding


We have discussed that this is the most convenient treatment for my particular case, although other alternatives exist.

This procedure has been explained to me. My questions regarding such treatment, its alternatives, its complications and risks have been answered by the doctor, therapist and or written information.

The information that I have been given is clear to me and I understand the risks and complications of the treatment. My questions have been fully and completely answered. I have read this document and understand its contents.

I give my permission to take photographs of all treated sites for diagnostic purposes and to accurately document the medical record in the usual and customary manner.
I agree that these photographs are the property of the clinic.

I will not make any claim or complaints either to the business owner owners, the employees, and the producer of the products.

I hereby give my unrestricted informed consent for the facial and body peels procedure.