• Waxing Forms

    Consultation & Consent Form
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  • Contact Preference*

  • Referred by:

  • Client Health History

  • Have you ever been waxed before?*

  • If "Yes", please explain any reactions you experienced:

  • Have you taken any anti-biotics, acne or skin medication (ex: Accutane, Roaccutane and Retinol)?*
  • Have you taken any medications that can cause blood thinning?*
  • Are you using any exfoliating, skin peeling/thinning products (ex: Alpha Hydroxy Acids (AHA) or glycolic products)?*
  • Have you recently, or plan to receive any facial treatments that involve the above products?*

  • If "Yes" to any of the above questions, please explain when the last time you used these products:

  • Please list all current medications you are taking (including over-the-counter herbs, vitamins and supplements):

  • Please list any allergies that you have (including cosmetics/ingredients):

  • Are you recently or currently have any of the following contraindications?*

  • Any other health conditions not listed:

  • Are you pregnant or nursing?*
  • Are you, or have you ever been treated for cancer?*

  • If "Yes", when and what type of therapies were used:

  • Have you ever had Botox, Juvederm or any other injectables?*
  • How fast do you feel your hair grows?*

  • Is there anything else we should know?

  • Pre & Post Treatment Care Guide

  • Before your appointment: 

    • Wear comfy loose clothing.
    • Avoid drinking caffeine and alcohol as it causes your skin to become more red and inflammed than usual.
    • If you are menstrating, please know that your skin is extra sensitive during this time. It is ultimately your decision to proceed or reschedule.
    • Avoid using exfoliating products at least 3 days before your appointment.

    During the initial 24-48 hours after your appointment: Do not touch or scratch the serviced area as bacteria can easily enter your opened hair follicles.

    • Keep the serviced area clean. No body products.
    • Avoid anything that causes friction in the serviced area.
    • Avoid heat and steam.
    • Avoid swimming.
    • Avoid activities that cause you to sweat.
    • Avoid tanning, including sunbeds, direct sunlight, and spray tans.

    Home Care Guide:

    • If redness or irritation occurs, apply a cool damp compress to the area. If symptoms presist after 24-48 hours, seek medical attention.
    • Avoid exfoliating products 3 to 4 days after your appointment.

  • Informed Consent

    Although every precaution will be taken to ensure your safety and well-being before, during, and after your waxing service, please be aware of the following information and possible risks. Please Initial:

  • Acknowledge & Waiver

    I am over 18 years of age and consent to the agreement and treatment, or have a parent with me that consents to this service.

  • This agreement will remain in effect for this procedure and all future procedures conducted by my esthetician, Jessica Mae Tagalicud. I give permission to my esthetician to perform the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment. I understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I release my technician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application, using tools and products that the technician has been professionally trained to use. I understand the aftercare instructions and will do my part to care for the waxed area. I understand the risks of failure to follow my estheticians aftercare instructions and will hold her harmless from any liability that may result due to my neglagence.

    By signing below, I verify that I have read and understand the above statements and agree to them.

  • Date
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    2 digit month, 2 digit day, 4 digit year
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