CoffeeBerry PeelDownload Consultation Card
We aim to ensure clients have the best possible advice both prior to and post-treatment. Please read the following information prior to booking an appointment in the salon.
- Consultation Information: to ensure you are not contraindicated to any treatment.
- Pretreatment Advice: should be read prior to attending an appointment.
- Aftercare Advice: to be read following your appointment for best results.
Children under the age of 16 should have consent from a parent or guardian prior to any appointment.
FACIAL PEEL – CoffeeBerry® Natureceuticals™
Do you have any of the following?
- Hay Fever
- Sensitive Skin
- Dry Skin
- Sensitive Eyes
- Herpes, Cold Sores or Fever Blisters
Are you presently using or taking any prescription drugs for a skin condition? (Such as Accutane, Tazorac, Retin-A, Antibiotics, and Corticoid Steroid)
Have you ever taken any of these drugs for a skin condition in the past?
Do you have any other skin conditions? Please explain:
Are you allergic or have you ever had any adverse reactions to medications? If yes, what type?
Are you allergic to or have you ever had an adverse reaction to cosmetics, foods, clothing, soap, shampoo, hair dye, perfumes or jewelry? Yes/No
If yes, to what?
Are you currently taking any medication? If yes, what kind?
Have you had any medical/health problems occur recently?
Did you go on holiday recently, where your skin faced a dramatic climatic change? (Sun, snow, wind etc) Yes/No
If yes, please explain:
Have you recently had any change in your diet, lifestyle or beauty regime? Yes/No
If yes, please explain:
Have you used active skincare products in the past, or are you presently using active skincare products such as Alpha Hydroxy or Retinol?
Pre Chemical Peel Contraindications That Indicate Peel Should Not Be Performed:
- Inflamed Acne Cyst
- Recent Retin-A Use
- Roacutane Use
- Pregnant or Nursing
- Open Wounds
- Sunburned Skin
- Allergy to Aspirin
- Severe Physical or Mental Stress
- Allergy to PRIORI homecare products
- Allergy to hair dyes
- Active Herpes
- Recent Hair Removal (48 hours)
- Irritated or Damaged Skin
- Clay Masks, Scrubs or Additional Agents (48 hours)
- Please note that the peel procedure can remove self-tanning products.
- Microdermabrasion, laser resurfacing or other facial treatments such as chemical peels, Botox, skin fillers, laser skin treatments or plastic surgery should be completely healed before proceeding with many PRIORI Skincare treatments.
Skin Indications For The Peels (reason for the peel to be performed)
- Acne/Acne Scarring
- Facial Erythema
- Blocked Pores/Follicles
- Photo Damage
- Dry, Dehydrated Skin
- Dull Skin
- Fine Lines
- Improve Skin Texture
Priori Product Prior Use:
If you have a history of sensitive skin please confirm that you have been using Priori skincare for two weeks prior to tis treatment taking place and please identify which products you have been using..
- All other facial treatment procedures used outside the 48 hours should have left the skin completely healed and normalized before having an Idebenone peel.
- The skin care specialist has explained the peel and contraindications of this form to me and I fully understand and agree with the consultation.
- I understand a mild redness or slight irritation may occur temporarily and subside.
- I must wait 48 hours before using the Idebenone Priori Eye Serum, and 24 hours before using any other Idebenone Priori homecare or other skincare products.
- I understand maximum results from the peels will be achieved with a course- generally 6 peels, in conjunction with homecare products.
- I understand due to the variable nature of the skin, no guarantee can be made to me regarding the results of the treatment.
- I confirm that I have received a copy of the pre and post peel instruction sheet.
- For best results skin should be acclimated to PRIORI® home skincare products for at least two weeks prior to first peel procedure.
- Avoid using clay masks, scrubs or additional exfoliating agents for at least 48 hours prior to each procedure.
- Do not use self-tanning agents for at least 48 hours prior to each procedure.
- Do not use Retin-A or any other similar Vitamin A compound for at least 48 hours prior to each procedure.
- The PRIORI® PRO Peel procedure will not be performed if a breakout of cold sores, fever blisters or herpes is present anywhere on the face prior to the procedure.
- The PRIORI® Pro Peel procedure should not be performed on sunburned skin.
- Do not have facial hair waxed within 48 hours before a skin peel application.
- If you have recently undergone any other facial treatment procedures, such as microdermabrasion, laser resurfacing, chemical peels, Botox®, skin fillers, facial plastic surgery, etc., skin must be completely healed and normalised prior to receiving a PRIORI® Pro Peel.
- Generally, make-up can be applied immediately after each PRIORI® Pro Peel procedure. We recommend the use of PRIORI® Perfecting Minerals Perfecting Foundation and Perfecting Concealer with SPF 25.
- Avoid exercise for at least a few hours after each procedure.
- Avoid direct sun exposure; a sunscreen of SPF 15 or higher should be used daily throughout the entire PRIORI® PRO Peel program.
- Wait one day after each PRIORI® Pro Peel before resuming the PRIORI® home skincare products. If irritation occurs, do not resume use of PRIORI® home skincare products until the skin has normalized.
- Do not use Retin-A or any other similar Vitamin A compound for at least 48 hours after a PRIORI® Pro Peel, unless directed.
- Facial hair should not be waxed for 48 hours after a PRIORI® Pro Peel.
- Avoid the use of steam, saunas, hooded hairdryers, etc. for 8 hours following a PRIORI®
- Pro Peel.