GUEST CONSENT FORM
Name
First Name
Last Name
Date of Birth (if under 18 must be accompanied by parent or guardian.)
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Preferred Method of Contact
Email
Phone
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
First Time Wax
YES
NO
Current Oral or Topical Medications
Medications Taken in Past Two Months
Have You Used or are Currently Using Accutane?(if yes indicate date of last treatment. Must be at least 6 months prior to visit.)
Have You Recently Been Overexposed to Sun or Any UV Rays? (if yes, please explain)
Do you Have Any Allergies That May Affect Your Treatment or Treatment Results? (if yes, please explain)
Facial Coverings Must be Worn During All Services for the Safety of Specialist and Clients
Date
-
Month
-
Day
Year
Date
Signature
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Submit
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