TCA Peel Pigment Lightening

Pre-Care & Informed Consent

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Last Name

Phone *

Email *

PLEASE READ

Pre-Procedure Instructions for TCA Peel

Pre-Procedure Instructions:

To ensure the safest and most effective results, I agree to follow all pre-care instructions provided. I understand that failure to follow these instructions may increase the risk of adverse reactions and impact results.

Avoid sun exposure, tanning beds, and sunburn for 7–10 days prior.

Discontinue retinols, exfoliants (AHAs/BHAs), and active skincare 5–7 days prior.

Avoid waxing, threading, tweezing, or brow lamination 5–7 days prior.

Do not undergo other facial treatments (peels, microneedling, laser) within 2 weeks.

Arrive with clean, product-free brows.

Notify provider of any skin conditions, sensitivities, or medications.

Contraindications

Pregnancy or nursing
Active infection or irritation in the brow area
Recent use of Accutane (within 6–12 months)
History of keloid scarring

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Informed Consent for TCA Peel

TCA Peel may cause:

Temporary redness, swelling, dryness, peeling, and sensitivity
Uneven pigment lightening or multiple sessions required
Temporary or permanent hyperpigmentation or hypopigmentation
Infection, scarring, or delayed healing (rare)
Skin may appear darker before lightening

I understand that TCA Peel Pigment Lightening is a cosmetic procedure intended to gradually lighten pigment through controlled chemical exfoliation. Results vary and are not guaranteed.

I agree

Medical Disclosure

I confirm that I have disclosed all relevant medical history, including medications, skin conditions, allergies, and previous procedures.

I have previously completed a Client Medical Profile Form for Julie Michaud. *

Yes, and it is up-to-date and correct

Yes, but I need to update it

No, I have not completed a Client Medical Profile yet

* If you need to update or have not completed one, you will be re-directed to the Client Medical Profile form upon submission of this consent form.

Media Consent

I consent to any relevant photographs being taken both before and after the procedure, to document the results of the procedure strictly for internal use. *

I consent

I consent to Julie Michaud using non-personally-identifying “before & after” photos of me for marketing purposes to display its capabilities and results. If I do provide consent, I may at any time withdraw such consent for specific photographs by contacting Julie Michaud, which will then discontinue use of said photo(s). *

Yes

No, I do not want my photos shared.

Liability Waiver

I have been given the full opportunity to ask any and all questions which I might have about obtaining a TCA Peel with Julie Michaud, and that all of my questions have been answered to my full and total satisfaction.

I have received no warranties or guarantees with respect to the benefits to be realized from, or consequences of, the aforementioned procedure(s).

I acknowledge that at the time of signing this consent I am of sound mind and capable of making independent decisions for myself.

I release the Julie Michaud from liability for adverse outcomes except in cases of gross negligence.

I understand this contract is to remain in effect for as long as I remain a client of Julie Michaud and all its contents apply whenever work is being performed on myself. It is my responsibility to inform Julie Michaud if any changes have occurred in my medical history.

By signing this form I acknowledge that I have read and understand the contents of each statement above.

I agree

Signature for TCA Peel Consent

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