Waxing/Tinting Consent Form

Customer Name

First NameLast Name

Customer Email

example@example.com

Customer Phone Number

Please enter a valid phone number.

Customer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Age

Gender

Please answer the health and skin checker for the safety of the procedure:

	Yes	No	Remarks
Have you done any waxing before?
Are you currently taking any medications?
Have you had any skin thinning treatments before?
Are you Pregnant? (Female)
When is your next menstrual cycle? (Female)
Do you have sensitive skin?
Do you have skin allergies?
Do you bruise easily?
Are you prone to scarring and hyperpigmentation?

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

Please note that waxing and/or tint does have certain side effects such as skin removal, redness, swelling, tenderness, etc. I give permission to my esthetician to perform the waxing and/or tint procedure we have discussed and will hold #WAX 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 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 #WAX immediately. I agree to inform my esthetician if I introduce new medications or topical products to my daily routine. 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 #WAX 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 and with future treatments. In the event that the client is a under the age of 18 (I am a legal guardian of the client listed above and I give my consent and understand the agreement)

No Call No Show/Less Than 24 Hr. Cancelation Agreement: I understand and agree that a NO CALL NO SHOW or Canceling my appointment less than 24 hours in advance will result in a fee that is equal to 50% of the scheduled service. I give the consent to charge my credit card that I have left on file in the event of a NO CALL NO SHOW or I give less than 24 hours notice of a cancelation.

How did you hear about #WAX?

Customer Signature

Date Signed

Date

Waxing/Tinting Consent Form

Waiver Consent