Waxing Intake Form

Waxing Intake Form
Name*

First NameLast Name
Date of birth *

MonthDayYear
Date
Todays date*

MonthDayYear
Date
Email*
example@example.com
MaleFemale
How did you hear about Smooth Secret Studio? *
If referred from a friend , who?
List friends name above
YesNo
If you have had a reaction to waxing, please explain..
YesNo
Yes
If you are under the age of 18 you must have a parent or guardian with you at your appointment and also have filled out the parental consent form with your parent/guardians signature.
The following may be potential contraindications for waxing:
YesNo
YesNo
YesNo
YesNo
YesNo
If so, when?
YesNo
YesNo
If yes, when?
Accutane or TetracyclineRetinoids such as Retin-A, Renova or DiferinAHA/Alpha-Hydroxy AcidsBHA/ Beta-Hydroxy AcidsGlycolic AcidAny other medicationsNone
If yes, what type/medications?
YesNo
YesNo
YesNo
YesNo
If yes, to what?
Ingrown HairsScarringBumpsHyperpigmentationBruisingNone
Yes
𝙋𝙍𝙀-𝙒𝘼𝙓 𝙏𝙄𝙋𝙎:
~ Gently exfoliate and moisturize a day before your wax appointment. This will help lift ingrown hairs and remove dry skin for a more comfortable wax.

~ Body hair should be at least 1/4 inch long (the length of a grain of rice)

~ Do not apply fake tan or use the sun bed 24 hours beforehand

~ Come in with loose clothing

~ Brazilian and Bikini line can still be performed if it is your time of the month. Just make sure to wear a tampon!
𝙋𝙊𝙎𝙏 𝙒𝘼𝙓 𝙏𝙄𝙋𝙎:
~ Keep the area that was waxed, clean. Avoid scratching, touching, itching, heat and friction. Wear loose clothing.

~ Do not take a hot bath or shower right afterwards. Do not use scented bath or shower products.

~ Do not go swimming or to the gym for at least 24 hours

~Do not use a sunbed or go tanning for at least 48 hours .
Consent and Signature
I understand that if I begin use, or currently are using, any of the products in the above warning and do not inform the esthetician prior to current or future appointments, I accept full responsibility for any adverse reactions.

I understand that waxing can cause some redness, bumps, soreness and/or itching.
Signature*

Clear
Should be Empty:

Waxing Intake Form

Consent and Signature