Waxing Consent Form

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Age

Haave you used any Alpha Hydroxy Acids (AHA) or glycolic products in the past 48-72 hours?

YesNo

Have you used Retin-A, Renova, or Accutane within the past year? If so, when?

Are you using any other skin thinning products and/or drugs that thin the blood?

YesNo

Do you use tanning beds and/or are exposed to the sun on a regular basis?

YesNo

Are you currently taking any medications? If so, please list.

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

Please list any illness/conditions which ou are currently being treated for by a medical professional.

Do you have any open skin lesions?

YesNo

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

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

I have read the above information and have given an accurate account of the questions and if I have any concerns, I will address these with my Technician. I give permission to my Technician to perform the waxing procedure we have discussed. The treatments I receive here are voluntary and I release my technician from liability and assume full responsibility thereof. I agree to adhere to all safety post care including: no peels, tanning, or wet room services; no swimming/spas/hot tubs for 72 hours after waxing; and all home skin care protocols as recommended by my service provider. I understand that my Technicain will take every precaution to minimize or eliminate negative reactions as much as possible.

I am acknowledging that I am 18 years of age or older and have read and understand the terms. **Parents must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.

Signature

Date?

Type a question