Waxing—Client Information and Consent Form

Full Name*

First NameLast Name

Date of Birth*

Calendar

Gender*

Phone *

E-mail *

example@example.com

How do you prefer to be contacted by Prisma Wax + Beauty?*

Text MeCall MeEmail MeAll options are okay

Prisma Wax + Beauty sends text and/or email confirmation/reminders before your appointment, is that okay? *

May we add you to our email list? (Please note that we do not rent or sell your information)*

Emergency Contact *

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Phone Number *

Who were you referred by? Or How did you hear about us? *

Have you ever been waxed before?*

Choose the type(s) of Waxing Service that you have previously received. Check all that may apply.*

FacialBodyBrazilianOther

Did you have any negative reactions? If so, please list them below. *

Are you getting Brow Tinting and/or Lamination Today? *

If so, have you ever had Brow Tinting and/or Lamination before? *

Did you have any negative reactions to Brow Tinting and/or Lamination? If so, please list them below. *

If you are allergic or think you may have allergies to a Brow Lamination, TINT, or adhesives, please let your Aesthetician know, and a patch test will be done before your service. If not, you waive the patch test and are aware of the consequences if you are allergic, and you will not hold your Aesthetician or Prisma Wax + Beauty responsible for any allergic reactions after your service is completed. ***First time clients, MUST get a patch test done.****

I would like to take the patch test.I waive the patch test.I am a new client or new to service I would like a patch test.

Are you using any of these products?*

If you have, when was the last time you used those products?*

If you have NOT, please type N/A.

Are you using any other skin thinning products and/or drugs? *

Are you using any antibiotics, blood thinners, antidiabetic medications, and/or cortisone? *

Do you or have you had and of the following conditions?*

Do you currently have any open skin lesions *

Are you exposed to the sun on a daily basis or are you considering spending more time in the sun soon?*

Do you use a tanning bed? *

Do you bruise easily? *

Do you have any skin conditions? If so, please list below. *

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

Are you currently taking medications? If so, please list all (including over the counter drugs/herbal supplements):*

What skin products do you regularly use on your skin?*

Have you ever been treated for cancer? If yes, when and what types of therapies were used?*

Please list any other illness/condition you are currently being treated for by a medical professional.*

Please Read the following statements.

Please note that waxing does have certain side effects such as skin removal/lifting, redness, swelling, tenderness, etc.

I have read the above information 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 and her staff harmless from any liability that may result from this treatment.

I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically.

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

I have read and understand the post-treatment home care instructions. I am willing to follow recommendations made by my Aesthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product / post-treatment care, I will consult my Aesthetician immediately.

I give the Aesthetician and Prisma Wax + Beauty permission to use before and after photos of me, my face, parts of my body, and eyes under the following conditions: social media and advertising purposes. I understand there will be no compensation.*

Consent to Take & Publish Photographs

In connection with my skin care services that I am receiving from Prisma Wax + Beauty, I consent that photographs may be taken of me, or parts of my body, under the following conditions:

1. The photographs shall be used for my client record. If in the judgment of my skin care professional, Aesthetician, education or science will be benefitted by their use or the use by Prisma Wax + Beauty, such photographs relating to my case, may be published and/or republished, either separately or in connection with each other, in professional journals, medical books, skin care magazines, slides, or used for any purpose which she/he may deep proper in the interest of medical education, knowledge, or research, provided, however; it is specifically understood that in any such publication or use I shall not be identified by name.

2. The aforementioned photographs may be modified or retouched in any way my skin care therapist, or Aesthetician, at her/his discretion, may consider desirable. In addition, the photographs may be used for advertising and/or social media purposes.

I also understand that there will be no compensation involved.

I give my Consent to Take & Publish Photographs.I DO NOT give my Consent to Take & Publish Photographs.

Sickness/Illness Policy

Please reschedule your appointment as soon as you are aware of an infectious or contagious condition.

Please always reschedule if you or your immediate family is ill or has been in the last 48 hours. We work very closely with clients and take every precaution to keep our spa safe and sanitary.

If you arrive for your appointment with symptoms of an illness, due to health and safety reasons, you will be required to reschedule your appointment.

If you experience any of the following symptoms, you must reschedule:

Fever or Chills
Vomiting or Diarrhea
Runny Nose
Sore Throat or Cough
You are currently taking an antibiotic.
You have a skin infection like ringworm or athletes foot.
You or someone in your direct care has a cold, sinus infection, or flu.
You or someone in your direct care has been diagnosed with influenza (the flu).

Cancellation Policies

***Appointments will be prepaid upon booking***
Appointments canceled less than 24 hours notice will forfeit 50% of prepaid appointment. No shows will automatically forfeit 100% of their prepaid appointment.

No Call/No Show: If you no call/ no show you will forfeit 100% of your prepaid appointment.

Late Arrival: If you are 15 minutes or more late to any appointment, it will be canceled and you will forfeit 50% of your prepaid appointment.

Rescheduling: You are allowed to reschedule twice per appointment, without penalty. Rescheduling your appointment in excess of this will result in cancellation and 100% forfeiture of that prepaid appointment. Canceling or rescheduling your appointment less than 24 hours in advance will result in forfeiting 50% of your prepaid appointment.

Please text or call 832.430.4046 to cancel or reschedule your appointment more than 24 hours before your appointment time.

Please text or call 832.430.4046 to cancel or reschedule your appointment more than 24 hours before your appointment time.

Our time is valuable and so is yours. We provide services by appointment only. When you book an appointment at Prisma Wax + Beauty you are purchasing time with us so that we may provide you with our expert services. As your Aesthetician, I am committed to having enough time to serve you.

Please arrive on time for your appointments.

Clients will only be taken earlier than their scheduled appointment time if they have been contacted prior to their scheduled appointment time and offered the option of an earlier start time.

Please keep in mind that we have scheduled breaks and a time to eat lunch during our busy day.

If you need to cancel or reschedule your appointment, please do so at least 24 hours prior to your scheduled appointment; we know that life gets busy and sometimes things come up.

Please be respectful of our time and the time of Prisma’s other clients. The cancellation/ no show policy will always be enforced.

Hygiene Policy

Please be sure the area being serviced is clean, as wax adheres best to clean skin and hair that is free from dirt/debris. For Body Waxing/ Brazilian Waxing appointments, to get the most out of your waxing appointment, please cleanse the area thoroughly and avoid heavy lotions/oils prior to coming in for your appointment. If the area is not clean or in an unsanitary state, you will be required to reschedule your appointment. Intimate/Hygienic wipes are provided for our guests to freshen up prior to their service.

Please DO NOT shave before or in between your appointments. If you would like to trim the hair, if it is longer than a 1/2 inch, you may use trimmers or scissors to trim to at least 1/4 to 1/2 inch (about as long as a grain of rice). If the hair is too long, there will be more discomfort; while, if the hair is too short, you will not get the most out of your waxing service, as the wax may not pick up hairs that are too short.

Also, some waxing services will require some specific positioning and participation on your part. You may be asked to hold the skin tight in a certain area, so that the most comfortable service and best results can be achieved. However, there is no need to stress about it, as your Aesthetician will guide you through this!

***Female Clients:

When scheduling your appointment around your menstrual cycle, always allow five days. Because of water retention and for your own personal comfort, you should avoid hair removal 2-3 days before your cycle is due and 2-3 days after it is completed, if you are very sensitive to pain during this time. Some are more sensitive during this time. Please keep this in mind when scheduling your appointment around your cycle.

If you wish to keep your waxing appointment during your menstrual cycle, you may definitely do so!

Please keep in mind the possibility of being extra sensitive, as mentioned above.
Please place a fresh tampon in right before your waxing appointment begins, or keep your menstrual cup in place.

Prisma Wax + Beauty’s Additional Terms

By scheduling an appointment with Prisma Wax + Beauty you are agreeing to this cancellation/ no show policy in its entirety.
Scheduling an appointment will be your agreement to these policies and act as your automatic authorization for any subsequent fees.

Late Arrival:
If you are running late, please notify us via phone call or text. Unfortunately, appointment times cannot be extended as it unfairly affects other clients’ schedules.

If you are less than 15 minutes late for your scheduled reservation time, We may not be able to provide the full treatment, but will perform an abbreviated treatment at the full price, if time allows.

If you are more than 15 minutes late, there will not be enough time to perform even an abbreviated service and your service will have to be rescheduled for a later date. This will be considered a last-minute cancellation and the cancellation policy above will apply.

Scheduled Appointments / Rebooking
Appointments are required (No Walk-Ins).
It is highly recommend to pre-book your next appointment either online or upon checkout to best accommodate your schedule and get the date and time you would like.

Appointment Reminder Notifications:
Appointment confirmation texts and emails will be sent before your scheduled appointment. Because it is a courtesy, please do not rely on these texts to determine whether or not you show up to your appointment. A personal calendar-reminder is recommended, as you are still responsible for either keeping or canceling/ rescheduling your appointments accordingly.

Prisma Wax + Beauty requires that you give at least a 24 hour notice to cancel or reschedule an appointment.

Refusal of Service:

Prisma Wax + Beauty reserves the right to refuse service to any individual, based on:

Lack of client compliance during treatment series
Client not complying with pre and post-care instructions
Client non-compliance with home care product use
Habitual tardiness/cancellations
Disregard of our professional advice is a waste of our time and your money.
Rude or inappropriate behavior.

Prisma Wax + Beauty has a ZERO-TOLERANCE policy for inappropriate behavior.

Please refrain from touching your Aesthetician during your service, in any manner.

Please do not block or touch the area being serviced during your appointment; this will interrupt your service and may possibly cause your service to be terminated.

Any attempt of advances in a lewd/sexual nature, suggestive behavior or language, innuendos, coercing, sexual harassment, intimidation, etc. will be considered a violation of this policy AND will warrant IMMEDIATE POLICE INVOLVEMENT.

Minors / Teens:

Minor teens and children coming in for appointments must be accompanied by their parent or guardian during the ENTIRE appointment. All intake/consent forms for minors must be signed by their parent or guardian at the start of every appointment.

Please do not bring your children with you to your appointment as your service should be a time for you to take for yourself.

Returns / Refunds:

Due to the nature of the services provided, all services are non-refundable. You have purchased time for us to provide you with an expert skill set. To prevent any issues, products are recommended to maintain results and information is offered to aid in aftercare. Please contact us within 48 hours of the completion of service if you are in any way dissatisfied with the service you received so that we can reach a solution.

ALL fees are non-refundable.

If you are a new client, in order to ensure you are receiving the correct products for your skin and that you follow a correctly prescribed regimen, you will need to schedule a consultation before you will be able to purchase products. Complimentary consultations are available.

Etiquette: Please keep voices down upon entering the building as other services may be in session. Turn your cell phone off or put it on silent to ensure your service or another service is not interrupted. If you need to make any calls please do so outside.

Privacy Policy:
Prisma Wax + Beauty has created this privacy policy to demonstrate our firm commitment to your privacy and the protection of your information.

We respect the privacy of our customers and will not release any customer information to third parties. We will never trade, sell, rent, or share addresses or any other personal information with anyone. Any information obtained is used for to process your order or maintain your client file only. Email and physical addresses are used solely for the purpose of communication between Prisma Wax + Beauty and clients. We respect your time and attention by controlling the frequency of any mailings.

Disclaimer:
Professional advice given at Prisma Wax + Beauty during a service, any phone calls, text messages, emails with your Aesthetician, as well as any articles and/or other information contained within this website or on our social media feeds is for informational use and is not intended to diagnose or treat any medical condition, and should not be considered medical advice. If you are experiencing a medical condition please seek the advice of your health care provider. If during your service something is seen that could be a potential medical condition, then you will be advised to see your medical provider. This should never be construed as medical advice or diagnosis. Personal/Professional opinions or advice as to any indication of diagnosis will not be given. You will always be advised to seek the advice of your Primary Care Provider.

Informed Consent

By typing my first name, last name, and providing my e-signature below, I am indicating the following:

1. I have read the New Client Intake Form for Prisma Wax + Beauty Bar in its entirety.

2. I fully understand all questions and information provided in the New Client Intake Form for Prisma Wax + Beauty Bar.

3. Any medications listed above are contraindicated for waxing and may result in skin irritation, peeling or hyperpigmentation.

4. I understand that if I begin using any of the above products and do not inform my Aesthetician prior to hair removal, I am accepting full responsibility for any skin reactions. Minor redness and sensitivity is normal from waxing.

5. I understand that if I have the Herpes Virus and do not obtain an antiviral medication prior to treatment of the area, the procedure may trigger an outbreak and I accept full responsibility for this. I also understand that if I have an active breakout at this time, waxing services will not be performed until they have gone and healed.

6. Avoid sun, heat, and certain products as directed for at least 24-48 hours after waxing. The hair-removal process has been thoroughly explained to me, and I have had an opportunity to ask questions and receive satisfactory answers.

7. I have completed the New Client Intake Form for Prisma Wax + Beauty Bar accurately and to the best of my knowledge.

8. I have read and I understand the expectations and policies for Prisma Wax + Beauty Bar and I agree to the terms and conditions outlined.

Type Full Name *

First NameLast Name

Client’s Signature *

DateTime

Client Intake Form-Waxing

Consent to Take & Publish Photographs

Sickness/Illness Policy

Cancellation Policies

Hygiene Policy

***Female Clients:

Prisma Wax + Beauty’s Additional Terms

Prisma Wax + Beauty has a ZERO-TOLERANCE policy for inappropriate behavior.

Informed Consent