Zo Peel Consent Form

Skinlogic Med Spa recommends using an at-home regimen of skin health productsto maximize the benefits.  This screening will determine who is a good candidate for the ZO 3 step Peel Protocol. YES answers to any of the following questions may disqualify you                                                 

  Are you pregnant or lactating?

  Have you used Accutane® or any prescription retinoid products

  (Retin-A®. Renova®) in the last 3 months?

  Have you used products containing retinol in the past week?

  Are you allergic or sensitive to aspirin?

  Are you undergoing any type of radiation or chemotherapy?

  Do you have herpes or cold sores?

  Within the last week. have you had any facial waxing, electrolysis or used any depilatories?

  Do you have any form of auto-immune disease (diabetes. lupus. etc.)?

  Do you have a sensitivity or allergy to:

  Have you had facial cosmetic surgery in the last month (laser resurfacing, dermabrasion. chemical peel. face lift. blepharoplasty, Botox®. in jectible fillers)?

  In the past 4 weeks have you been exposed to the sun? 

  If so, do you have a suntan?

* Note: Some redness is anticipated after the peel.



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Document name: Zo Peel Consent Form
lock iconUnique Document ID: 33f9be6764d4b0392ce7a74fabe36920990ae92e
Timestamp Audit
May 27, 2020 12:13 am PDTZo Peel Consent Form Uploaded by Skinlogic Med Spa - infossc2001@gmail.com IP