Waxing Intake & Consent Form

You may experience skin sensitivity/thinning, which can result in skin lifting, from the following:

- Sunburned Skin - Rentinol

- Pregnancy - Antibiotics

- Menstruation

- Certain Medical Conditions

- Other Medications Not Listed
If you are using any of the following medications, you CAN NOT be waxed today:

AccutaneRenovaAdapaleneAlustraAvageTararoteneAvitaIsotretinoin

PLEASE READ

I UNDERSTAND THAT IF I BEGIN USE, OR ARE CURRENTLY USING, ANY OF THE PRODUCTS LISTED IN THE ABOVE WARNING AND CHOOSE NOT TO INFORM THE ESTHETICIAN PRIOR TO CURRENT OR FUTURE TREATMENTS, I ACCEPT FULL RESPONSIBILITY FOR ANY ADVERSE REACTIONS.

I UNDERSTAND THAT WAXING MAY CAUSE SOME TENDERNESS, SWELLING, REDNESS, BUMPS, SORENESS, AND/OR ITCHING.

I have read the above information and have given an accurate account of the questions and if I have any concerns, I will address these with my Esthetician. 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 agree to adhere to all safety post care including: no peels, tanning, no sex for 24 hours, no wet room services; no swimming/spas/hot tubs for 72 hours after waxing; and all home skin care protocols as recommended by my service provider. I understand that my Esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.
CLIENT CONSENT (OVER 18YRS OF AGE):

Clear
PARENT/GUARDIAN CONSENT ( UNDER 18 YRS OF AGE) :
I, Signature , Authorize MD ESTHETICSTRY to provide waxing services (with the exclusion of Brazilian Waxing Services) on Signature ( a Minor).
NO BRAZILIAN WAXES WILL BE PROVIDED FOR MINORS.
Should be Empty: