Beauty Elevated Waxing Consent Form

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Format: (000) 000-0000.

Date Of Birth

When is the last time you shaved?

Is this your first wax?

Have you used any Alpha Hydroxy Acids (AHA) or glycolic products in the past 48-72 hours?

Have you used Retin-A, Renova, or Differin? If so, when?

Have you used Accutane in the past year?

Are you using any other skin thinning products and/or drugs that thin the blood?

Do you use tanning beds and/or are exposed to the sun on a regular basis?

Are you currently taking any medications? If so, please list.

Have you been treated for cancer? If yes, when and what types of therapies were used?

Please list any illnesses/conditions which you are currently being treated for by a medical professional.

Do you have any open skin lesions?

Do you have any allergies? If so, please list.

Before & after photos will be taken. If you are receiving a Brazilian your face will not be shown. Do you we have your consent to post your photos?

Please note that waxing can have certain side effects such as skin removal, redness, swelling, tenderness, etc.

I have read the above information and have given an accurate account of the questions and if I have any concerns, I will address these with my Esthetician. I give permission to my Esthetician to perform the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment. I agree to adhere to all safety post care including: no peels, tanning, or wet room services; no swimming/spas/hot tubs for 72 hours after waxing; and all home skin care protocols as recommended by my service provider. I understand that my Esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.

**Waxing is never done on clients taking Accutane and is not recommended for clients taking Retin A, Renova, Differin or other types of skin thinning acne medications.

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There is a 50% service fee for cancellations within 24 hours of the scheduled appointment. The cancellation fee is non-refundable and non-transferable.

Please be sure to make ANY CHANGES to your appointment 24 hours prior to the start of your service. This includes having multiple services booked and changing it to just one service. Doing this after 24 hours will result in 50% charge of the late cancelled service.

There is a 100% service fee for any no shows. This service fee is non-refundable and non-transferable

Clients will have a 10 minute grace period for any appointment over 20 minutes and 5 minute grace period for appointments under 20 minutes. If client hasn’t arrived within 5 or 10 minutes, client will be marked as a no show and late cancellation fee will be applied.

By booking an appointment you agree to the cancellation, no show, and late policy

Signature

Date?