Studio Soothe Waxing Consent Form
PLEASE USE TAB KEY TO NAVIGATE AFTER YOUR ANSWERS ARE TYPED IN EACH BOX. PRESSING “ENTER” OR “RETURN” WILL SUBMIT AN UNFINISHED FORM AND YOU’LL HAVE TO START OVER.
Name
First Name
Last Name
Date of your service
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Month
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Day
Year
Date
Phone Number
Please enter a valid phone number. Preferably a cell so we can text you with appointment confirmations and to invite you in when we are ready for you.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
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Month
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Day
Year
Date
Therapist you have an appointment with. If you don’t know say N/A
Who can we thank for telling you about us?
Are you pregnant?
Do you have any medical problems? If yes, please explain
Are you allergic to Latex, any products, oils or foods (like nuts?) If yes, please list them and your reactions to them.
Understanding waxing and the potential risks involved
Have you ever had any waxing before? If yes, what was the date?
Are you sensitive to heat?
Have you ever had a reaction to waxing?
While never intended, you do understand that waxing is a treatment with heat and that it can cause burning and occasional bruising?
With the above knowledge you are willing to be waxed?
Within the last year have you been under a Dermatologist’s care? If so, what conditions were being treated?
Have you had any chemical peels, dermabrasion or any resurfacing treatments in the past? If so, please give date of your last treatment:
Do use any Retin-A, Renova, Adapalene, Accutane, Epiduo or any prescription for your face or body where waxing will take place? If so please list them.
Have you used any of these prescriptions in the last 30 days?
Are you currently using any products containing the following ingredients: AHA’s, Glycolic acid, Lactic acid, scrubs or Retinols on areas to be waxed? If so please list them and when last applied.
Do you have Eczema or Psoriasis?
If you have Eczema or Psoriasis or any other skin disorder, you acknowledge that waxing can cause irritation to your disorder and you agree to take full responsibility for any reaction you have with your own Doctor: Please initial
PLEASE INITIAL THE FOLLOWING
You understand you are responsible for payment of 100% of the cost of the service now and in the future if you cannot make your appointment(s) or cancel within 24 hours of the service:
You agree to call us or email us outside the 24 hour cancelation window if you need to cancel your future appointments:
You certify that you do not have any special occasions, weddings or any other important event with in two weeks of this appointment. You totally understand that skin care, massage therapy and waxing can potentially cause skin reactions and Studio Soothe cannot be held responsible for any reaction you may have as a result of your service. If you wish to reschedule, you may do so outside of our 24 hour cancellation policy window.
I understand that if I choose to still have my appointment within two weeks of my “special event” as listed above, Studio Soothe will ask that the Online Waiver of Liability also be filled out and signed. After finishing this consent form please return to the Form page and fill out the Waiver of Liability.
You understand that if you are verbally abusive or sexually suggestive to anyone at Studio Soothe you will be asked to leave and charged the full amount for the service:
You understand that you are a participant at Studio Soothe and though our massage therapists check in, it is up to you to communicate with us if we are using too much pressure, if you are too hot or cold or if any of our products don’t feel right to you. You agree that you will communicate what is happening with you during your service so we can try to correct it. (We are here to help!)
If you are unhappy with your practitioner, your service or any other issue you have with Studio Soothe, you agree to contact us via our contact page on our website or a phone call to let us know! (We want to get it right!)
Please certify that as of the date of your service you are at least 18 years of age.
I knowingly and willingly consent to having waxing/hair removal service(s) now and in the future during the COVID-19 pandemic.
To prevent the spread of contagious viruses and to help protect each other, I understand that i will have to follow the Studio Soothe’s strict COVID-19 guidelines. https://www.studiosoothe.com/covid19-information
I agree not to come to the salon if I’ve had any of these symptoms UNEXPLAINED within 24 hours of your service. Symptoms of COVID-19 listed below: Fever, Temperature, Shortness of breath, Loss of sense of taste or smell, Dry cough, Runny nose, Sore throat. If I have any of these Unexplained symptoms I will call Studio Soothe asap 415-674-7511 to reschedule my appointment at no charge. Please help us after 7 months of closure to do this as soon as you possibly can. We much appreciate the help and effort.
I verify I have not traveled outside the United States In the past 14 days before the date of my service.
I understand that while Studio Soothe is in compliance with city/ county/ state guidelines and diligent in their Capacity limits, Proper PPE and cleaning that entering any facility is a risk and we cannot guarantee you will not contract COVID-19.
Today’s date
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Month
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Day
Year
Date
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