Waxing waiver

Waxing Consent Waiver
Full Name *

First Name Last Name
Have you taken accutane within the past year ? *

Yes No
Are you using Retin-A, Differin, or Renova? *

Yes No
Are you taking any medication that make you photosensitive? *

Yes No
Are you currently sunburn? *

Yes No
Do you currently have or have you had any of the following medical conditions that could compromise your skin and/or services being offered? *

AIDS/HIV ECZEMA/PSORIASIS HEPATITIS HERPES VARICOSE VEINS CANCER COLD SORES None of the above
You may experience skin sensitivity/ thinning, which can result in skin lifting, from the following:

Sunburn skin Pregnancy Menstruation Retinol Antibiotics Certain Medical Conditons
Consent and Signature:

I understand that if I begin use, or are currently using any of the products listed in the above warning and do not inform the esthetician prior to current or future treatment, I accept full responsibility for any adverse reactions.

I understand that waxing may cause redness, bumps, soreness and or itching.
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Waxing Consent Waiver