Waxing Client Consultation Form

WAXING CLIENT CONSULTATION FORM
How did you hear about Skintuition? *
If a friend referred you, please share their name
Do you already have an appointment scheduled? *

Yes, I'm all set! Not yet, please have someone contact me
If you haven't opted in for TEXT MESSAGE APPOINTMENT REMINDERS, do we have your permission to do so? *

Yes No
Name *
Date of Birth *

Month Day Year
Age *
Email Address *
Phone Number *
Can we communicate with you via text message and/or email? *

Yes No
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Emergency Contact *
Relationship *
Emergency Contact Phone Number *
Lifestyle
What is your occupation? *
What are some things you like to do in your spare time? *
How often do you receive professional waxing services? *

Weekly Every 2 Weeks Monthly Quarterly Special Occasions Never
When is the last time you had a professional waxing service? *
Have you ever had an unpleasant waxing experience at a salon or spa? Please share if you like.
Do you experience any of the following conditions on your face or body? *

Age Spots Dry Irritated Sensitive Warts None
Health History
Do you have any of the following health conditions? *

Anemia Arthritis, Tendinitis, Bursitis Autoimmune Disease Circulatory Problems Cancer Cold Hands or Feet Dermatitis Diabetes (Type 1 or 2) Excema Fibromyalgia Fungal Infection Heart Problems Hepatitis High or Low Blood Pressure HIV/AIDS Kidney Problems Lymphedema Osteoporosis Pregnancy Scoliosis Stroke Thyroidism (Hypo or Hyper) Tuberculosis Varicose Veins NONE
What medications are you currently taking and their purpose (include topical medications)? *
If NONE, please enter NONE in the box
Do you have allergies to: *

NO KNOWN ALLERGIES Artificial Fragrance Fruits Tree Nuts
Please explain what happens when you are exposed to what you are allergic to, if applicable.
Policies to Keep Business Running Smoothly
I acknowledge that with any optional nailcare service, certain risks are involved and that complications from known or unknown causes could occur. If I am receiving elective spa services and I experience any unusual side effects, I will contact Skintuition Holistic Skincare immediately.

I understand that if I purchase a package of services or products, individual results vary and I will not be given a monetary refund if I am unsatisfied. I will be offered a credit to use toward other services or products within a reasonable amount of time if proper notification is given.

CANCELLATION POLICY
- ONLINE CANCELLATIONS accepted up to 72 hrs BEFORE YOUR SCHEDULED APPOINTMENT
- APPOINTMENT CHANGES OR CANCELLATIONS WITHIN 72 hrs of your scheduled appointment, CALL or TEXT (703) 653-0567 and we will handle it for you
- $75 NON-REFUNDABLE FEE charged for LAST MINUTE CANCELLATIONS WITHIN 48 HRS of scheduled appointment and NO SHOWS
I acknowledge and accept Skintuition Holistic Skincare policies as stated above *

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WAXING CLIENT CONSULTATION FORM

Lifestyle

Health History

Policies to Keep Business Running Smoothly