Waxing Consent Form

Name*

First NameLast Name

Email

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Age?

Have you used any Alpha Hydroxy Acids (AHA), Salicylic Acid (BHA), glycolic, or other exfoliating products in the past 48-72 hours?*

YesNoOther

Are you using any other skin thinning products and/or drugs that thin the blood?*

YesNo

Have you used Retin-A, Renova, or Accutane within the past 6 months? If so, when?*

Do you use tanning beds and/or are exposed to the sun on a regular basis?*

YesNo

Have you been treated for cancer? If yes, when and what types of therapies were used?

Have you had any facial or body care treatments within the past 7 days?*

YesNo

Are you currently taking any medications? If so, please list.

Please list any illness/conditions which you are currently being treated for by a medical professional.

Do you have any open skin lesions?

YesNo

Do you have any allergies? If so, please list.*

Please note that waxing can have certain side effects such as skin removal, redness, swelling, tenderness, etc.

I have read the above information and have given an accurate account of the questions and if I have any concerns, I will address these with my Esthetician. I give permission to my Esthetician to perform the waxing procedure we have discussed and will not hold her or The Babe Cave Beauty Bar for any liability that may result from this treatment. The Babe Cave Beauty Bar and its staff providing waxing services are not responsibile for any liability pertaining to services. I agree to adhere to all safety post care including: no peels/exfoliants, tanning, or wet room services; no swimming/spas/hot tubs for 72 hours after waxing; and all home skin care protocols as recommended by my service provider. I understand that my Esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. I fully understand to stop use of all active ingredients for atleast 7 days prior to any waxing service, failure to do so will result in skin lifting during the hair removal service. I understand that it is my responsibility to update The Babe Cave Beauty Bar and its staff of any new medication prescriptions and use of new facial products. It is solely the client's responsibility to follow proper aftercare to prevent irritation, skin lifting, break outs, and any other skin conditions following after the service provided.

Signature*

Date?*