Waxing Consent Form 2023

This form must be completed by every client before their service begins. Only required to complete once a year.

Full Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone Number

Format: (000) 000-0000.

How did you hear about Kairopractic Skin?

Have you used any Alpha Hydroxy Acids (AHA) or Glycolic products in the past 48-72 hours? Physical or Chemical exfoliants

6. Are you using Retin-a, Renova, Tretinoin or Accutane (an oral form of Retin-a)?

Are you exposed to the sun on a daily basis or are you considering spending more time in the sun sometime soon?

Are you diabetic?

9. Are you currently taking medications or vitamins/suppliments? If so, please list them all.

10. What skin products do you regularly use on your skin?

11. Have you ever been treated for cancer? If yes, when & what types of therapies were used?

12. Please list any other illness/condition you are currently being treated for by a medical professional

PHOTO CONSENT & RELEASE: Kairopractic Skin asks for yourpermission to take pictures or videos of your service either before, after or during to be used toeither track progress or post for promotional purposes.Do you give permission for your photos or videos to be used on Social Media platforms or for other marketing purposes? Check whichever box below you are consenting to:

BOOKING POLICIES: At the time of booking, a card must be entered to be held on file for no show protection.Deposits are required in order to secure your appointment.For services $50 & up, a deposit is required of 50% of the service.All deposits are non refundable (All deposits go towards your service). DEPOSITS MUST BE SENT WITHIN 1 HOUR OF BOOKING. PLEASE SEND THEM VIA ZELLE AT: 415-717-6085. ONCE DEPOSIT IS SENT, I WILL APPROVE YOUR APPOINTMENT. You are able to reschedule or cancel your appointment within 48 hours of your scheduled appointment time.Canceling or rescheduling within less than 48 hours notice will forfeit your deposit. Meaning that your deposit will not be refunded.Your deposit is transferable ONCE. Otherwise, a new deposit is needed to rebook. For the one time exception, please contact me via TEXT or EMAIL directly.Payment is due at the end of your service and must be paid in FULL. Forms of payment accepted: This is a CASH (exact change ONLY) or Zelle. Cancellation Policy: A 48 hour notice is required to cancel or reschedule your appointment. You must cancel or reschedule your appointment on your own through the booking site. Failure to do so, will result in forfeiting your deposit. A new deposit will be needed in order to re-book.Again, Your deposit is transferable ONCE. Otherwise, a new deposit is needed to rebook. For the one time exception, please contact me via TEXT or EMAIL directly.*Note Canceling on social media is not a proper or professional way to contact your esthetician. No Show Policy: If you no show to your appointment you will be charged the remainder of your scheduled service(s) balance.No shows are not acceptable or tolerated. The second time you no show, you will be blocked from making any future appointments with me. Late Policy: Due to COVID-19 I have given myself extra time in between appointments to properly clean & disinfect my space for the next person to enter.With this needed time to clean, tardiness is not acceptable. It is not fair to me or my client following after you.**THIS MEANS BEING INSIDE MY TREATMENT ROOM AND NOT IN THE PARKING LOT or RESTROOM**If you are more than 7 minutes late, I will no longer be able to take you, and you will be noted as a NO SHOW and charged the remainder of your scheduled service(s). Service Downgrade: If you have multiple services booked at the time of your appointment and you try to cancel/remove any of the services after the 48 hour mark or during your appointment, you will forfeit your deposit for the service(s) no longer wanted. EXAMPLE: You booked a Vajacial + Wax, but decide a few hours before your appointment time that you only want to receive the Wax and not the Vajacial. You will forfeit your deposit for the service(s) no longer wanted. Waxing While on My Period: Canceling or downgrading your appointment due to your monthly cycle will no longer be acceptable. If you do not cancel, reschedule or make any modifications to your appointments before the 48 hour mark you will forfeit your deposit. Please plan your waxes around your cycle or insert a fresh tampon as well as taking some over the counter pain meds to help with the discomfort if you choose to move forward with waxing while on your period. Guests: There are no additional guests allowed in the treatment room other than the person receiving the service and the Esthetician performing the services.Guests are welcomed to wait in the hallway. Refunds: Absolutely no refunds for products or services. Thank you.

Please note that waxing does have certain side effects such as skin removal, redness, swelling, tenderness, etc. I have read the above information and if I have any concerns, I will address these with my esthetician, Jennifer Picazo. I give permission to my Esthetician, Jennifer Picazo to perform the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment. I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. I have read and understand the post-treatment home care instructions. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product / post-treatment care, I will consult my esthetician, Jennifer Picazo immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold my esthetician, Jennifer Picazo, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today. By also signing this form I agree to abide by Kairopractic Skin's Booking Policies stated on the Booking app at the time of booking this appointment.

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