Language
English (US)
Waxing Consent Form
Thank you for choosing All Dolled Up Beauty Bar. We are looking forward to a long and lengthy communication.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
-
Area Code
Phone Number
How often do you have waxing done?
Have you ever had a reaction to a waxing service?
Yes
No
If yes, please describe:
Do you have any tendencies to:
Ingrown Hair
Scarring
Bumps
Hyperpigmentation
Bruising
Are you allergic to anything?
Yes
No
If yes, please describe:
Have you received Botox treatments in the last 72 hours?
Yes
No
Have you been or will you be in the sun and/or tanning bed within 24 hours of this treatment?
Yes
No
Are you using or taking:
Accutane or Tetracycline
Retinoids such as Retin-A, Renova or Diferin
AHA/Alpha-Hydroxy Acid
BHA/Beta-Hydroxy Acid
Glycolic Acid
Are you currently pregnant?
Yes
No
Do you have Diabetes, Phlebitis or any skin irritation?
Yes
No
Is you skin dry?
Yes
No
Client Signature
Clear
Date
-
Month
-
Day
Year
Date
Esthetician Signature
Clear
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty:
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