Waxing Consent Form

Waxing Consent Form
Name *

First Name Last Name
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Appointment Date *

Month Day Year
Date
Nufree finipil hair removal should not be combined with any other products.

Your technician will only be using Nufree approved epilating strips, applicators, erasing lotion if necessary, and finipil antiseptic.

No alcohols, astringents or powders can be applied before removal.

After the removal is complete, finipil antiseptic will be applied to instantly cool and protect the now empty follicle.
Have you taken Accutane in the past year? *

Yes No
Are you currently using Retin-A, Differin or Renova? *

Yes No
Are you taking any medications that make you photosensitive? *

Yes No
Do you frequent tanning beds? *

Yes No
Are you currently sunburn? *

Yes No
Are you diabetic? *

Yes No
If you have any medical conditions that could effect your skin during the waxing services, make them known by selecting the appropriate boxes below. *

AIDS/HIV Eczema /Psoriasis Herpes (Cold Sores /Fever Blisters) Hepatitis Cancer Varicose Veins None of the above
Read the warnings and the consent paragraph before signing the document. If you are under 18 years of age, a parent or guardian must complete the bottom section of the consent form.
If you are using any of the following medications, you cannot be waxed today:

Accutane ~ Adapalene ~ Isotretinoin ~ Retin A ~ Renova ~ Alustria ~ Avita ~ Tazarotene ~ Tretinoin ~ Avage ~ Differin

You may experience skin sensivity / thinning, which can result in skin lifting, from the following:

*Sunburned skin

*Retinol

*Certain medical conditions

*Pregnancy

*Antibiotics

*Menstruation

*Other medications not listed
In order for your technician to perform an efficient hair removal, you must have at least 7-10 days hair growth for your 1st appointment and your 2nd appointment should be atleast 3-4 weeks later.
CONSENT AND SIGNATURE:

I understand that if I being use, or are currently using, any of the products listed in the above warning anddo not inform the technician prior to current or future appointments, I accept full responsibility for any adverse reactions.

I understand that waxing may cause some redness, bumps, soreness and/or itching.
I am over 18 years of age, and by typing my name below, I confirm to the best of my knowledge that the answers I have given are correct and I have not withheld any information. *
PARENT/GUARDIAN CONSENT (UNDER 18 YEARS OF AGE):
I, First Name Last Name authorize Dolce Medical Spa, Organic Salon & Salt Room to perform a waxing treatment on First Name Last Name (minor).
By typing my name below, I consent to treatment for the minor listed.
Should be Empty:

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