WAXING CONSENT FORM
Thank you for choosing EN Signature Brow and Beauty studio for your services. We love to give every client the best quality service. Please fill out the form below.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
I have not used a scrub, Retin-A, Retinol OTC, take home micro-dermabrasion, glycolic peels, other peels, exfoliated or tanned in the last 72 hours.
Yes, I have
No, I have not
I have been off of Accutane for at least twelve (12) months.
Yes
No
Some possible side effects include redness, swelling and pimples, but these are temporary and generally fade within 72 hours.
Yes, I understand
No
I am over 18 years of age or I have parental consent co-signed below.
Yes, I’m 18 years or older
No, But I Have My Parental consent
I am not 18 years of age but my parents has consent to the risks of this service. Parental Signature below.
Clear
Print Parental/Guardians name:
first and last name
I give Elizaveta Neginskaya permission to take, publish and reproduce photographs of me, my face, and/or my eye area, both before and/or after the procedure for advertising and other purposes.
Yes
No
For Brazilian and/or bikini waxing clients only:
I will notify my service provider if I am on my menstrual cycle.
Yes, I will
Other
I do not have any open skin lesions or active herpes outbreak (cold sore or genital).
I do not.
My signature acknowledges that I have read and agree to receive the treatments or series of treatments listed above and that I will adhere to all of the aforementioned statements that I have initialed.
*
Clear
REFUND POLICY: Individual services, promotional services, sale services, series services, gift certificates purchased for your self or for another individual are absolutely non-refundable. This applies to all of the procedures offered at the salon. There are NO REFUNDS on any procedures or services we have already initiated or already completed. NO EXCEPTIONS.
*
Clear
Date
*
-
Month
-
Day
Year
Date
Please fill out email to receive after care instructions.
*
example@example.com
Submit
Should be Empty: