Waxing Consent Form

Client’s Full Name

First NameLast Name

Instagram Username

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Age

Rows	Yes	No	Remarks
Have you had this service performed on you before?
Do you have sensitive skin?
Do you bruise easily?
Are you prone to scarring and hyperpigmentation?
Are you using any skin thinning products and/or drugs that thin the blood?
Do you use tanning beds and/or exposed to sun on a regular basis?
Do you have any open skin lesions?

Are you using any of the following medications or products that may contain the following substances ?

Are you currently taking any medications ? If so please list and provide the date in which they were last used.

Please list any illness/conditions which you are currently being treated for by a medical professional.

Have you been treated for cancer ? If yes, when and what types of therapies were used ?

I under that with treatment certain risks are involved and that any complications or side effects from known or unknown causes could occur. I freely assume these risks and release Mysthetics LLC of all liability in relation to the service(s) being provided.

I agree if I may begin to use, or are currently using any products or have any services done that may be a contraindication to a waxing services, I will inform Mysthetics LLC prior to current or future services. If I fail to do so I will accept full responsibility for any adverse reactions.

I may experience skin sensitivity/thinning, which can result in skin lifting from the following:
Sunburned skin, retinol, certain medical conditions, pregnancy, menstration, antibiotics, or other medication not listed.
It is understood that waxing may cause some possible effects that include redness, swelling, bumps, soreness, and/or itchiness.

This agreement will remain in effect for this service and all future follow-ups conducted by Mysthetics LLC. I understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. My signature acknowledges that I have read and agree to receive the treatments or series of treatments and I will adhere to all aforementioned statements that I have read.

Date

Signature

Waxing Consent Form

Please answer the questions below for the safety of the procedure:

Please read the following below before signing