WAXING CONSENT FORM

CLIENT NAME*

CONTACT NUMBER*

ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

BIRTH DATE*

MonthDayYear

EMAIL*

example@example.com

HOW DID YOU HEAR ABOUT EN?

BROW RESHAPECHINLIPFULL FACE

BRAZILIANBIKINI LINE

OTHER

THE FOLLOWING MAY DETERMINE WHETHER YOU ARE AN IDEAL CANDIDATE FOR WAXING

ANY SKIN CONCERNS YOUR ESTHI SHOULD BE MADE AWARE OF?

HAVE YOU HAD ANY ADVERSE REACTIONS OR ALLERGIES? PLEASE ADVISE

ARE YOU CURRENTLY TAKING ANY MEDICATION THAT MAY BE A CONTRAINDICATION TO WAXING? PLEASE ADVISE

YES! I HERBY GRANT PERMISSION TO ELEMENT NINE TO USE ANY PHOTOS AND/OR VIDEOS TAKEN OF ME ON SOCIAL MEDIA, OR PUBLICATIONS. ONLINE AND ANY OTHER COMMUNICATION RELATED TO ELEMENT NINE.NO! I DO NOT GRANT PERMISSION TO ELEMENT NINE TO USE ANY PHOTOS AND/OR VIDEOS TAKEN OF ME ON SOCIAL MEDIA, OR PUBLICATIONS. ONLINE AND ANY OTHER COMMUNICATION RELATED TO ELEMENT NINE.

INITIAL BELOW

I HAVE CITED ALL CONDITIONS AND CIRCUMSTANCES REGARDING MY HEALTH HISTORY Including any past reactions to products or medications that could prohibit or compromise this treatment (PLEASE INITIAL)

I UNDERSTAND THAT ADDITIONAL CONDITIONS COULD OCCUR WHICH COULD AFFECT MY ABILITY TO TOLERATE THIS WAXING TREATMENT I further understand there are risks associated. I acknowledge that my skin may experience temporary irritation and certain side effects such as skin removal, bumps, itching, redness, swelling, and/or tenderness depending on skin sensitivity. (PLEASE INITIAL)

I WILL NOT HOLD MY TECHNICIAN OR BUSINESS PERFORMING THIS SERVICE ON ME RESPONSIBLE IN ANY WAY FOR ANY ISSUES THAT MAY ARISE AS A RESULT OF HAVING THIS WAXING TREATMENT PERFORMED I understand that even though Element Nine uses the proper technique with utmost attention to safety and proper procedure protocols, the instruments and wax used may cause irritation. itching or discomfort and may require a medical professional's follow-up care. (PLEASE INITIAL)

I UNDERSTAND THAT AFTERCARE NEEDS TO BE FOLLOWED TO MAINTAIN THE HEALTH OF MY SKIN As part of my aftercare, I should minimize prolonged sun exposure. use sun protection and avoid aggressive exfoliation/beauty treatments on the area for at least 24 hours. (PLEASE INITIAL)

I CONSENT TO THE BEST OF MY KNOWLEDGE THAT THE ANSWERS I HAVE GIVEN ARE CORRECT AND THAT I HAVE NOT WITHHELD ANY INFORMATION THAT MAY BE RELEVANT TO MY TREATMENT

I release Element Nine any liability associated with any injuries and/or current and future conditions resulting from this waxing treatment

You hereby acknowledge and confirm that you are or have been fully informed to the nature of the service you have requested and are aware with all risks associated. You informed your technician of an pre-existing conditions, allergies or product sensitivities that may have an impact on treatment. We are not liable for any dissatifaction, discomfort, damage, loss or injury you may incur arising directly or indirectly out of any services provided or any product used. Complimentary services or treatments are only offered on the express understanding that the service offered is not and may not be deemed as an admission of liability or fault and are also subject to the conditions of this agreement.

Signature

DATE

Date

Waxing Consent

ELEMENT NINE DAY SPA

WHICH WAXING SERVICE IS BEING PERFORMED TODAY?

CONSENT FORM