Wax Consultation

Body & Facial Wax Consultation
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Birthday (MM/DD)
Are you at least 18 years old?
How did you hear about us?
Have you been waxed before?
Do you have a type of wax you prefer us to use?
Are you pregnant or nursing?
Are you currently taking any medications?
Please list any know allergies or write NONE
Are you currently using any products/taking any medications that contain
When was your last skin resurfacing treatment such as microdermabrasion or chemical peels or write none?
Have you had any dermal fillers, botox or other injectables in the past 2 weeks?
Have you ever had an adverse reaction to a waxing service?
What is your current skincare routine (if having a facial wax)?
Consent for treatment:

I give permission for Miss Melissa, LLC, dba The Nail and Wax Room, (and their associates) to treat me today. I have disclosed any allergies and current medical conditions. I release any liabilities that may arise during or after as a consequense of my treatment. If my treatments are ongoing, I will disclose any new allergies, medical conditions or medications at the time of my service.
Appointment Date

MonthDayYear
Date
Today's Date

MonthDayYear
Date
Signature
Should be Empty:

Body & Facial Wax Consultation