Client Information and Consent for Waxing

Client Information and Consent for Waxing
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
How did you hear about Wax Me Baby?*
Friend/Internet/Other
When was the last time you waxed/shaved?*
Have you waxed before?*
Yes or No
Have you used any Alpha Hydroxy Acid or Glycolic products?*
Yes or No
Are you using Retin-a, Renova or Accutane?*
Yes or No
Are you using any other skin thinning products? *
Yes or No
Are you currently taking any medications?*
Yes or No
****Please note that waxing does have certain risk and side effects such as skin removal, redness, bruising, scabs, swelling, tenderness etc.

By signing below, I am confirming that I have read and understand the above mentioned statement. I understand the procedure and accept the risk. I do not hold the esthetician and/or Wax Me Baby responsible for any conditions that may occur.
Client Signature*

Clear
Date

MonthDayYear
Date
Esthetician Signature

Clear
Should be Empty: