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*

Area CodePhone Number

Who Referred you to skinSPArations?*

Birthdate*

Date

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

YesNo

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?*

YesNo

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

YesNo

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?*

YesNo

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 NameLast Name

Signature*

Date?*

Hair Removal Form