Waxing Consent Form

Name

First Name Last Name

Email

example@example.com

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number

Area Code Phone Number

Who Referred you to skinSPArations?

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

Yes No

Have you used Retin-A, Renova, or Accutane within the past year? If so, when?

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

Yes No

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

Yes No

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 illness/conditions which you u are currently being treated for by a medical professional.

Do you have any open skin lesions?

Yes No

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

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 Aesthetician. I give permission to my Aesthetician 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 Aesthetician will take every precaution to minimize or eliminate negative reactions as much as possible.

I understand and agree to the Waxing precautions *

Initial

Cancellation Policy

To cancel an appointment please contact skinSPArations@gmail.com at least 24 hours prior to your appointment. Cancellations within 48 hours will be charged a fee of $25-$200 depending on the service.

I agree and understand the cancellation policy *

Initial

Care and Maintenance Terms

I understand some possible side effects include redness, swelling and bumps, but these are temporary histamine effects and generally fade within a few hours.

I understand my post care for the first 24-48hrs includes:

no peels, tanning or wet room services

no swimming/spas/hot tubs

no excessive rubbing, chaffing

no deodorants

no scented products such as shower gels, lotions, creams, powders

I understand it is recommended to reschedule every 4-6 weeks

I Agree to the Care and Maintenance Terms *

Initial

Full Name

First Name Last Name

Signature

Clear

Date?