State-of-the-art, personalized skin care
from experienced professionals
“A regular skin checkup can literally save your life.” Jennifer Krasnoff, MD

Chemical acid compounds in safe cosmetic concentrations are used under the supervision of physicians in cosmetic skincare programs. The recommended programs can be repeated as often as every one to two weeks in the absence of irritation or other possible side effects.

Most patients do not experience adverse effects from the use of chemical acid products. On occasion, temporary side effects such as mild swelling, redness, or peeling to mild scabbing have been experienced. These changes can generally be relieved by applying a mild cortisone cream or emollient cream. In the event any side effect or adverse reaction is experienced, notify your physician immediately and avoid using any harsh scrubs or irritating medication until you have recovered.

Chemical acid formulations are intended to slough the skin, but applications will not necessarily induce an actual visible peel. The formulations can create a tighter and firmer complexion. The programs recommended include the application of the products to the face for several minutes and then the thorough removal of the materials. Mild cooling agents, bland moisturizers and sunscreen may be used after treatment. The skin rejuvenation home care program designed for you may usually be resumed 24 to 48 hours after your peel unless your practitioner gives you with other special instructions.

Benefits of the chemical acid peel program include improvement in the overall appearance of the skin through softening of fine lines, combating dry skin, smoothing out rough texture and reducing pigmentary problems. To achieve best results, a program of at least six consecutive in-office applications under physician supervision should be undertaken with diligent adherence to the home skincare program, a necessary supplement to the professional applications.

I agree that pre- & post-operative clinical photographs and videos may be taken to monitor my treatment progress and for patient educational purposes. I understand that my identity will be protected.

I certify that I have read and understand the contents of this consent form. I have been given the opportunity to ask the doctor/staff any questions that I have about the procedure, and all of my questions have been answered. The doctor/staff has explained the procedure and its alternatives to me, and I both understand and accept the risks involved in this procedure. I hereby authorize my doctor and his/her assistant to proceed with the chemical acid peel program.

Please download this PDF form to sign.





Petaluma Office
165 Lynch Creek Way
Petaluma, CA 94954
 M-F, 8:00am-5:00pm
(707) 762-5531
Fax: (707) 762-5976



Hercules Office
500 Alfred Nobel Dr., Ste. 245
Hercules, CA 94547
M-F, 8:00am-5:00pm
Open Saturday for aesthetic services
 (510) 741-7418
Fax: (510) 741-7456


Billing office
Fax: 510- 741-7493

At Dermatology Associates of the Bay Area, our board-certified dermatologists serve patients at our Petaluma and Hercules offices. We are committed to the highest standards, and we offer a full range of cosmetic, medical, and surgical dermatology procedures, as well as quality skin care products.

Dermatology Associates of the Bay Area
165 Lynch Creek Way | Petaluma, California 94954 | Phone: (707) 762-5531 | Fax: (707) 762-5976
500 Alfred Nobel Drive, Suite 245 | Hercules, California 94547 | Phone: (510) 741-7418 | Fax: (510) 741-7456