Waxing Consultation & Informed Consent

Full name

First NameLast Name

Phone Number

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Email

example@example.com

Your age

Date of birth

Date

Gender

FemaleMaleOther

How were you referred to me?

Have you ever had an adverse reaction to hair removal treatments? If yes, select “other” and explain:

YesNoOther

Have you ever had an adverse / allergic reaction to a skincare treatment, product, or ingredient? If yes, select “other” and explain:

YesNoOther

Please list any known allergies you may have.

Do you have any tendencies to (select all that apply):

Are you currently taking Accutane, Tetracycline, or any other oral acne medications? If yes, select “other” and explain:

YesNoOther

Are you currently using Glycolic Acid, Lactic Acid, Salicylic Acid, AHA (alpha hydroxy acid), BHA (beta hydroxy acid), or retinoids such as Retin-A, Renova, Differin or any other topical medications to treat acne or wrinkles? If yes, select “other” and explain:

YesNoOther

Please list any and all medications you are currently taking.

Please read the following information.

Waxing is a form of temporary hair removal that removes the hair from the follicle, or root.

Waxing may have some side effects including, but not limited to: redness, scabbing, bruising, swelling, tenderness, hyperpigmentation, bumps, breakouts, ingrown hairs, and other histamine reactions. *These reactions are rare, but do happen on occasion. They may be exacerbated by the use of certain medications, particularly those used for anti-aging and anti-acne treatments. Examples of these are: retinoid, retin-a, renova, accutane, and alpha hydroxy acid (AHA), like glycolic acid. Face waxing should be avoided when using these products.

Clients who are receiving aesthetic and dermatological peeling treatments may also experience extra redness and/or lifting of the skin from waxing, and therefore should avoid waxing while undergoing these treatments.

Because the fields of pharmacology and dermatology are continuously changing and expanding, there may be products and drugs that cause negative reactions to waxing that have yet to be documented.

* PLEASE READ THE BELOW WARNINGS *

If you are using any of the below medications, you cannot be waxed.

Accutane

Renov

Tretinoin

Adapalene

Alustr

Avage

Avita

Differin

Retin-A

Tazarotene

You may experience skin thinning - which likely results in skin lifting from the following:

pregnancy

menstruation

antibiotics

oral acne medications

topical medications for acne & wrinkles

sunburned skin

skin recently exposed to the sun and/or tanning beds

certain medical conditions

other medications not listed

I agree to allow Janée Farris to perform waxing services, vajacials, eyebrow lamination services, skin lightening services, and/or any other services I schedule myself for during any future appointments.

I agree

I understand that Janée is licensed to perform these services in the state of California, and follows all safety and sanitation practices, including (but not limited to) all COVID-19 precautions.

I agree

I understand what this treatment entails and my service provider has answered any questions about the service.

I agree

I am aware that discomfort may occur.

I agree

I agree to avoid the following for 24 hours after my treatments: excessive sweating, tight clothing, sexual activity, saunas, steam rooms, hot tubs, sun exposure, or other heat sources.

I agree

I agree to avoid the following for 72 hours before and after my treatments: alpha hydroxy acid (AHA), glycolic products, botox, fillers, and similar medical or other dermatological treatments.

I agree

I agree not to use retinol and other AHA products 7 days before or after my treatments.

I agree

I understand that certain medications may negatively affect my skin during a treatment, particularly those causing photosensitivity (sensitivity to sunlight). Examples of these are antibiotics and blood thinners. Use of these medications may cause the skin to bruise or lift easily, or be more susceptible to burns.

I agree

I agree to make my service provider aware of any medications I use so we can take the necessary precautions. I agree to let my service provider know of any changes to my medications.

I agree

I understand that if I begin use, or are currently taking any products listed in the above warnings, and do not inform my service provider prior to current or future treatments, I accept full responsibility for any adverse reactions.

I agree

I agree to follow all pre and post treatment aftercare instructions. I understand that not following these instructions may inhibit the results of my treatments and I accept full responsibility for any adverse reactions.

I agree

I understand that any changes to my appointments must be made more than 48 hours prior to the start of my appointment time. I agree to pay 50% of the cost of my services if I need to cancel or reschedule an appointment with less than 48 hours notice.

I agree

I understand that if I am more than 5 minutes late to my appointment, Janée may not be able to perform all of my service(s) and may need to reschedule some or all of my services. If a new appointment is required, I understand that a cancellation fee will be charged to my card kept on file.

I agree

I understand that after 10 minutes to the start of my appointment time, I am considered a no-show and will be charged 100% of the cost of my services to the card on file.

I agree

I have read and understand all of Janée’s policies and agree to follow them. I understand that Janée’s business policies may change from time to time, and it is my responsibility to keep up to date on any changes found on her booking website and Instagram account.

I agree

I am over 18 years of age, or have parental consent signed below.

I agree

I have read all the information above, and if I have any questions or concerns, I will address them with my service provider. I give Janée (Bare Botanicals) permission to perform the services discussed and will hold her and her business harmless from any and all liability that may result from previous treatments, today’s treatments, or future treatments. By signing this form, I agree to all terms listed above.

If the client is a minor, a legal guardian must be present during the entire service each time the minor is receiving a service. If the minor experiences unnecessary discomfort (per Janée’s assessment) and the client is uncomfortable or does not want to proceed with the service- the service will immediately discontinue and 50% of the incomplete treatments will be charged. Please list your name (legal guardian), your relationship, and sign below.

Legal Guardian Signature