Waxing Consent Form

Waxing Consent Form
CLIENT NAME*

PrefixFirst NameLast Name
Client Email*
example@example.com
Client Phone Number*
Please enter a valid phone number.
Customer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age*
Gender*

Please Select all that applies *

	Yes	No
Have you done any waxing before?
Are you currently taking any medications?
Have you had any skin thinning treatments before?
Are you Pregnant? (Female)
Do you have sensitive skin?
Do you have skin allergies?
Do you bruise easily?
Do you experience ingrown hairs?
Are you prone to scarring and/ or hyperpigmentation?

Do you currently have or have had any of the medical conditions that could compromise your skin and/or services being offered?*

	Yes	No
AIDS/HIV
Hepatitis
Varicose Veins
Eczema/ Psoriasis
Herpes
Cancer
Cold sores/ Fever Blister

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

Accutane Retin-A or retinoidsRenovaDifferinAHABHAGlycolic AcidNone of the Above
Waiver Consent
PLEASE be advised...

DO NOT BOOK a Brazilian or Bikini wax within the time of your active menstral cycle. If your menstral cycle becomes active on the day of service, please reschedule your appointment for a later date.

Also, PLEASE TRIM down the hairs before your appointment if it's long, but nothing shorter than the length of a RICE GRAIN.

The length or shortness of the hair, can possibly affect the deplilation process, making the hairs difficult to remove. Thank You!
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'll I agreed to the terms indicated in this document.
Date Signed*

MonthDayYear
Date
Customer Signature*

Clear
Should be Empty:

Waxing Consent Form

Waiver Consent