Simply Relaxed Waxing Consent Form

Client Name

First NameLast Name

Client Email

example@example.com

Client Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Client Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Age

Gender

Please answer the health and skin checker for the safety of the procedure:

Rows	Yes	No	Remarks
Have you done any waxing before?
Are you currently taking any medications?
Have you had any skin thinning treatments before?
Are you Pregnant? (Female)
When is your next menstrual cycle? (Female)
Do you have sensitive skin?
Do you have skin allergies?
Do you bruise easily?
Are you prone to scarring and hyperpigmentation?
Any recent surgery or dermabrasion?
Are you diabetic?

When did you last shave? blanks How often do you shave? blank

How would you rate your sensitivity to pain?

Are you currently using any cosmetic products that may contain the following substance? Kindly check if yes and if no, leave it blank.

Do you currently have or have you had any of the following medical conditions that could compromise your skin and or service being offered:

I am providing my consent to complete the procedure I am requesting for I am duly aware of the side effects of waxing to my skin during or after the procedure such as:
skin redness, swelling, skin irritation, bruises, or bumps.

I acknowledge and completed health and skin checker, efficiency, and accuracy.

I was instructed and enlightened that some cosmetic additives or chemical substances itemized were hazardous when coupled with waxing and may most likely cause disappointing results and side effects to my skin area.

I hereby affirm that I have read and fully understand the above, am over eighteen years of age and am legally liable for my own decisions/actions.

By signing below, it means that I agreed to the terms indicated in this document.

Customer Signature

Date Signed

Date

Waxing Consent Form

Waiver Consent