Waxing Consent Form

Full name

First name Last name

DOB:

Address

Street Address

CityState

Zip CodeCountry

Phone Number

Format: (000) 000-0000.

Email

example@example.com

How did you hear about us?

Have you ever had a reaction to a waxing service?

If yes, please describe:

How often do you have waxing done?

When did you last shave?

Do you have any allergies? If so, please list.

When is your next menstrual cycle due to begin?

Always allow five days for menstrual cycle. Because of water retention and for your own personal comfort, you should avoid hair removal two days before your cycle is due and two days after it is completed.

Are you currently pregnant?

Have you used any of the following in the past 48-72 hours?

Are you using any other skin thinning products and/or drugs?

If yes, please describe:

Are you exposed to the sun on a daily basis?

Do you use a tanning bed?

Have you experienced any of these health conditions in the past or present?

Are you currently taking any medications? If so, please list all (including over the counter drugs/herbal supplements):

What skin products do you regularly use on your skin?

Please read the following information below:

By checking this box, I agree to the policies set forward by Sweetescape Esthetics LLC. I acknowledge and understand that in order to secure my appointment I must leave a credit card on file. I also understand that my card will only be charged in the event of a late cancellation, and/or a no-show. I acknowledge and agree with Sweetescape Esthetics LLC NO-SHOW policy. I understand and agree that if I no-show the day of my appointment I will be charged 50% of that service. I also understand and agree that if I do not cancel within 24 hours. I will be charged 30% of the service.I release Sweet Escape Esthetics, LLC from any and all liability associated with this service. This service will be performed with the utmost attention to safety, sanitation, and proper application using tools and products that the technician has been trained and certified to use. This service has many variables due to lifestyle, moisture, weather, extreme temperatures and other factors. The Licensed Esthetician (along with my consent form and consultation) will decide if I am a good candidate for this service to the best of their ability.

I grant Sweetescape Esthetics LLC permission to use my before and after photos for marketing purposes. (Photos will only be taken of the mons pubis region, a towel will be provided to cover labia majora).

Please note that waxing can have certain side effects such as skin removal, redness, swelling, tenderness, etc.

Please note that waxing does have certain side effects such as skin removal, redness, swelling, tenderness, etc. I have read the above information and if I have any concerns, I will address these with my skin therapist. I give permission to my therapist to perform the waxing procedure we have discussed and will hold her and her staff harmless from any liability that may result from this treatment. I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.

I have read and understood the post-treatment home care instructions. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care, I will consult the esthetician immediately.

I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the esthetician, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.

Client's Name

First NameLast Name

Signature

Date

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