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I duly authorize Canvas Aesthetics (Pty) Ltd to perform the Lamelle Chemical Peel treatment. 

I understand that a Chemical Peel is a solution that harnesses the body’s natural processes of renewal, causing the skin to peel, allowing new skin to grow in its place and that this treatment is used for a variety of skin conditions of which I hereby consent to be a client receiving the Chemical Peel treatment on the specified area above for the specified concern.

I understand that clinical results may vary depending on individual factors, including medical history, skin type, client compliance with pre/post treatment instructions and individual response to treatments

I confirm that I have informed the staff regarding any current or past medical condition, disease or medication taken and that the list of contraindications has been fully explained to me. I also undertake to inform the staff of any changes to my medical condition or medication taken during the course of my treatment or any further future treatments.

I understand that there is a possibility of temporary Short-Term Effects which have been fully explained to me and that I will inform the staff of any adverse reactions within 24 hours of them occurring:

  • Swelling and puffiness may occur after 24-72 hours.
  • Redness after 72 hours could indicate irritation or allergy to an ingredient.
  • Itching can occur- oral anti-histamine can be taken.
  • Post inflammatory hyperpigmentation (PIH) can occur - Corrective Brighter Concentrate and Ovelle Supplement will minimize this risk.
  • Underlying congestion can be brought to the surface- whiteheads, blackheads and pustules can occur.
  • NB: For darker skin types, the skin will darken further before shedding.
  • Note, pigmentation may worsen after the first few peels as it’s brought closer to the surface of the skin – therefore a course of peels is suggested.

I have been fully informed and understand:

  • The treatment involves a series of sessions which need to be continued at set intervals dependent on the nature of the concern – failure to adhere will result in a less desired outcome
  • The nature and purpose of the treatments
  • Expected outcomes and possible short-term effects
  • The final result obtained cannot be guaranteed
  • The fee structure including the payment terms and conditions
  • The late arrival, no-show and cancellation policies
  • My condition is of cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so.

I confirm and understand that the Pre-Treatment Protocols have been fully explained to me and are important and advisable for the desired outcome and that I undertake to / have adhered to these requirements prior to my treatment.

I confirm and understand that the Post-Treatment Protocols have been fully explained to me and I will adhere to these requirements after my treatment. I also acknowledge and understand that Maintenance and additional Home Care Routines are advisable for effective and long-lasting results. 

I understand the importance of Before and After Photographs and consent to the following: 

  • The taking of my before and after photographs
  • Authorize their anonymous use for the purposes of medical audit, education and promotion.

I have read and fully understand the contents of this consent form.

Do you agree to the above terms and conditions?
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