WAXING CONSENT FORM

WAXING CONSENT FORM

OASIS BEAUTY STUDIO
Name

First NameLast Name
Date

MonthDayYear
Date
HAVE YOU TAKEN ACCUTANE WITH THE PAST YEAR?

YESNO
ARE YOU USING RETIN-A, DIFFERIN, OR RENOVA?

YESNO
ARE YOU TAKING ANY MEDICATIONS THAT MAKE YOU PHOTOSENSITIVE?

YESNO
ARE YOU CURRENTLY SUNBURN?

YESNO
ARE YOU DIABETIC?

YESNO
DO YOU CURRENTLY HAVE OR HAVE YOU HAD ANY OF THE FOLLOWING MEDICAL CONDITIONS THAT COULD COMPROMISE YOUR SKIN AND/OR SERVICES BEING OFFERED

AIDS/HIVHEPATITISVARICOSE VEINSECZEMA/PSORIASISHERPESCANCERCOLD SORES/FEVER BLISTERS
**PLEASE READ THE FOLLOWING WARNINGS
IF YOU ARE USING ANY OF THE FOLLOWING MEDICATIONS, YOU CAN NOT BE WAXED TODAY: ACCUTANE, ADAPALENE, ISOTRETINOIN, RENOVA, AVITA, ALUSTRA, RETIN-A, TAZAROTENE ,TRETINOIN, AVAGE, DIFFERIN

YOU MAY EXPERIENCE SKIN SENSITIVITY/THINNING, WHICH CAN RESULT IN SKIN LIFTING, FROM THE FOLLOWING: SUNBURNED SKIN, RETINOL, CERTAIN MEDICAL CONDITIONS, PREGNANCY, ANTIBIOTICS, OTHER MEDICATIONS NOT LISTED, MENSTRUATION
CONSENT AND SIGNATURE:
I UNDERSTAND THAT IF I BEGIN USE, OR ARE CURRENTLY USING, ANY OF THE PRODUCTS LISTED IN THE ABOVE WARNING AND DO NOT INFORM THE ESTHETICIAN PRIOR TO CURRENT OR FUTURE TREATMENTS, I ACCEPT FULL RESPONSIBILITY FOR ANY ADVERSE REACTIONS.

I UNDERSTAND THAT WAXING MAY CAUSE SOME REDNESS, BUMPS, SORENESS, AND/OR ITCHING.
CLIENT SIGNATURE:
PARENT/GUARDIAN CONSENT (UNDER 18 YRS OF AGE):
I,
, AUTHORIZE
WAXING TREATMENT ON
A MINOR
**IF ANY PROBLEMS OR ISSUES OCCUR POST WAXING, PLEASE CONTACT IMMEDIATELY!
Should be Empty:

WAXING CONSENT FORM

**PLEASE READ THE FOLLOWING WARNINGS

CONSENT AND SIGNATURE:

CLIENT SIGNATURE:

PARENT/GUARDIAN CONSENT (UNDER 18 YRS OF AGE):

WAXING TREATMENT ON

**IF ANY PROBLEMS OR ISSUES OCCUR POST WAXING, PLEASE CONTACT IMMEDIATELY!