Facial Wax Consent Form

  • 3141 E Broad St Suite 303 Room 114, Mansfield, TX 76063
    (682) 213-0798
    lealux.glossgenius.com

  • Facial Wax Consent Form

  • Client Details

  • Date of Birth*
     - -
  • Format: (000) 000-0000.

  • Medical Information

  • Have you ever had a reaction to a waxing service?*
  • Have you used any Alpha Hydroxy Acid (AHA) or glycolic products in the past 48-72 hours?*
  • Have you used Retin-a, Renova or Accutane (an oral form of Retin-a) in the past 6 months?*
  • Are you using any other skin thinning products and/or drugs?*
  • Do you have diabetes, phlebitis or any skin irritations?*
  • Are you receiving treatment for cancer related illnesses such as chemotherapy or radiation treatment?*
  • Have you been or will you be in the sun and/or tanning bed within 24 hours of this treatment?*

  • Aftercare Advice

    • No extreme heat treatments (e.g. very hot baths or showers, saunas, steam rooms), swimming, sunbathing (including sun beds or any other exposure to UV light) for 24 hours.
    • Do not apply any perfumed products to the area for 24 hours.
    • Wash your hands before scratching or touching the area.
    • Avoid the use of make-up on the waxed area for 24 hours, apart from mineral make-up or specialist post-treatment products.
    • No self-tanning products to the area for 24 hours.
    • Do not pluck or tweeze in-between appointments particularly in areas where your esthetician has advised re-growth.
    • Please inform us immediately if you experience any problems after your treatment, including prolonged swelling, an itchy rash, bruising, or any kind of skin grazing, cuts or tearing so that we can advise the correct treatment. In the unlikely event that your skin does not return to normal within 24 hours of your treatment, seek advice from your physician in case you have had an allergic reaction to the wax or in case an infection is developing.

  • Consent

    Please check each box to show your understanding and agreement.

  • Signature

    This agreement will remain in effect for this procedure and all future facial wax procedures. I will alert the esthetician if there are any future changes to my medical history. I have read and fully understand all information in this agreement. I am over 18 years of age and consent to the agreement and to the facial wax procedure.
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