WAX CONSENT FORM

Name

First Name Last Name

Date

Email

example@example.com

Phone Number

Area Code Phone Number

I give consent to othe service provider at Shear Luxury Day Spa to perform the following services:

Please Check All that Apply:

I have not used a scrub, Retin A, Retiol OTC, take hone micro dermabrasion, glycolic peels, other peels, exfoliated or tanned in last 72hrs. I have been off Accutane for at least 12 months. Some possible side effects include redness, swelling and pimples, but these are temporary and generally fade within 72hrs. For Brazilian and or bikini waxing Ii will notify my service provider if I am on my menstrual cycle. I do not have any open skin lesions or active herpes outbreak (cold sore or genital) I understand that with treatment certain risks are involved and the any complications or side effects form known or unknown causes could occur. I freely assume these risks. I agree to adhere to all safety post care including; No peels, tanning or wet room services; no swimming, spas, hot tubs for 72hrs after waxing; and all home skin care protocols as recommended by my service provider. I am over 18 yrs of age or I have parental consent co signed below. I will call to inform my service provider of any complications or concerns I may have as soon as the occur.

My signature acknowledges that I have read and agree to receive the treatments or series of treatments listed above and I will adhere to all of the aforementioned statments that I have checked.

Client or Guardian Signature

Clear

Date