Waxing Consent

Waxing Consent Form
Name*

First NameLast Name
YesNo
YesNo
YesNo
YesNo
Do you have any allergies? (Latex, beeswax, etc)
Tanning bedsSunbatheVery seldomNone of the above
YesNo
YesNo
AIDS/HIVEczema/psoriasisCold sores or fever blistersHepatitisHerpesCancerNone of the above
**Please review the following and inform your technician of any concerns.
If you are currently using any of these medications you CANNOT be waxed today.
1. Accutane
2. Adapalene
3. Renova
4. Tretinoin
5. Isotretinoin
6. Alustra
7. Avage
8. Avila
9. Differin
10. Retin-A
11. Tazarotene
You may experience skin sensitivity/thinning, which may result in skin lifting from the following:
1. Sunburnt skin
2. Pregnancy
3. Menstration
4. Retinol
5. Other medications not listed
6. Specific skin conditions (Rosacea, Eczema, etc.)
I understand that if I begin using or currently use any of the products listed and DO NOT inform my esthetician PRIOR to current or future appointments, I accept full responsibility for any adverse reactions and agree to hold BROWHAUS LLC harmless in such event.

I understand that waxing may cause some redness, bumps, soreness, and/or itching.

I understand that allergic reactions can happen at any time when applying cosmetics including wax, tint, and pre and post procedure balms. I agree to hold BROWHAUS LLC harmless in the event of such occurrence. I know that I can elect to have a patch test administered prior to my service date, and choosing not to will not hold BROWHAUS LLC liable.
I Full name * have read through the entire consultation form AND the cancellation policy and understand/agree to all the information listed in the text above.
Signature
Should be Empty:

Waxing Consent Form

**Please review the following and inform your technician of any concerns.