Brow and Face Wax/Tint Intake Form

WAXING/TINTING CONSENT FORM
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
WAXING
WAXING: Must be 18. or accompanied by a parent/guardian. No one under the age of 9 is permitted to be waxed.
YesNo
Anyone under 18 MUST have a parent or guardian present. Please list the name of the parent/guardian that will be at the appointment.
YesNo
If yes, please list medication below:
YesNo
YesNo
YesNo
YesNo
Please list any skin concerns or conditions below:
TINTING
YesNo
If you answered "No" to the above question it is recommended you do a patch test before your service. If you DO NOT wish to receive a patch test and want to proceed with the service please initial below:
YesNo
Date*

MonthDayYear
Date
By signing/dating below, confirm that the information given is accurate before proceeding with the service (For those under 18 years of age please have parent/guardian sign below):*

Clear
Print name:*
Should be Empty:

WAXING/TINTING CONSENT FORM