Name
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First Name
Last Name
Date?
*
Phone Number
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-
Area Code
Phone Number
Email
*
example@example.com
Have you used any Alpha Hydroxy Acids (AHA) or glycolic products in the past 48-72 hours?
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Yes
No
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?
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Yes
No
Do you use tanning beds and/or are exposed to the sun on a regular basis?
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Yes
No
Are you currently taking any medications? If so, please list.
Please list any illness/conditions which you are currently being treated for by a medical professional.
Do you have any open skin lesions?
Yes
No
Do you have any allergies? If so, please list.
I have read and agree to: 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 Esthetician. I give permission to my Esthetician to perform the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment. 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 Esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. No picking, scratching or pulling of the skin if irritation does occur.
*
I Agree
Reservation & Cancellation Policy for all current and future appointments: A 24 hour cancellation is required in order to fill the lost appointment time. in the event of cancellations received less than 24 hours prior to appointment, a cancellation fee of 50% will be charged on your next visit. No shows will be charged 100%
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I understand the reservation and cancellation policies at Spa Daze by Cate and consent upon next visit if I fail to give 24 hours notice for appointment scheduled.
Signature
*
Submit
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