VI Peel Body Client Consult Form

The VI Peel Body contains a synergistic blend of powerful ingredients suitable for all skin types. VI Peel Body will improve the tone, texture and clarity of the skin; reduce age spots, improve hyperpigmentation, soften stretch marks; clear acne skin conditions; reduce or eliminate acne scars; improve common conditions of the body like tinea versicolor, keratosis pilaris, and acanthosis nigricans while stimulating the production of collagen, for firmer, more youthful skin.
Contraindications:

• Patients who are pregnant or who are breast feeding
• Patients who have a phenol allergy or allergy to any of the ingredients in the peel including: Glycolic Acid, Lactic Acid, Mandelic Acid, Phenol, Trichloroacetic Acid, Aloe Vera, or Allantoin
• Patients who have used oral isotretinoin (Accutane) within the past 6 months
• Patients who have warts, open wounds, or history of herpes outbreaks
• Patients who are undergoing chemotherapy and or radiation therapy within 6 months
• Patients who have keloids, a history of keloids, hypertrophic scars or active skin cancer(s)
• Patients with a history of an autoimmune (i.e. Lupus) or liver disease/disorder as well as any condition that may weaken their immune system