WAXING CONSENT FORM

CLIENT INFORMATION

PLEASE FILL OUT THE FIELDS BELOW:
Date:

MonthDayYear
Name:

First NameLast Name
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CLIENT CONSULTATION

The following questions will ensure you have the best waxing service possible with the best results. Please be sure to answer all questions and reach out to Alexis if you have any questions/concerns prior to your service.
I am 18 years of age or have parental consent (signature required below)*

YESNO
Have you had laser treatment, electrolysis, microdermabrasion, glycolic peel, or any other peels, used a tanning bed, or waxed the area of today’s treatment within the last 72 hours?*

YESNO
Are you taking any medications, such as, hormones, antibioctics, acne medications (Accutane, Differin, Retinol), blood thinners (Aspirins or Coumadin)?*

YESNO
Have you been off Accutane for at least twelve (12) months.

YESNO
Do you have any open skin lesions on the area of today's treatment?*

YESNO
Are you currently on your menstrual cycle?*

YESNO
Please list any allergies you may have including plant, vegetable, cosmetic products, or medications:
POST TREATMENT & AFTERCARE

FOR THE BEST RESULTS, PLEASE FOLLOW THE RECOMMENDATIONS BELOW FOR THE NEXT 48 HOURS
- Wear clean and loose fitting clothing
- Do not apply deodorant, body spray, powder, or lotion
- Avoid touching the waxed area with unwashed hands
- Avoid swimming in chlorinated pools
- No hot baths, showers, saunas, hot tubs, or steam
- No sport, gym workout or other exercise
- No tanning (sunbathing, sun beds or fake tans)
TO PREVENT INGROWN HAIRS:
- 48 hours after your appointment and a few days every week, exfoliate the waxed area(s) using a dry brush or exfoliating mitt.
- Be sure not to exfoliate too often or too rough
- Do not shave between your appointments
- Moisturize every day
ACKNOWLEDGMENT & AGREEMENT

PLEASE READ & SIGN BELOW
I am aware that there are possible side effects of waxing and I may have unfavorable results such as, but not limited to, allergic reactions, redness, irritation, burning, pain, rashes, swelling, pimples, soreness, ingrown hairs, sun sensitivity, scarring, bleeding, itching, etc.

I have read and understand the information above and have answered all questions truthfully. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received and accept the risks.

I give permission to Alexis Nichols to perform the waxing service(s) discussed and release her from any liability that may result from my service. I agree that this constitutes full disclosure and it will supersede any previous verbal or written disclosures.

I further understand that it’s my responsibility to inform my provider if any of the above changes.
CLIENT SIGNATURE:

Clear
PARENT/GUARDIAN CONSENT (UNDER 18 YRS OF AGE):

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Should be Empty:

CLIENT INFORMATION

CLIENT CONSULTATION

POST TREATMENT & AFTERCARE

ACKNOWLEDGMENT & AGREEMENT