• Waxing consent form

  • Format: (000) 000-0000.
  • Date of Birth*
     - -
  • Medical History*
  • Have you been treated for cancer?*
  • Do you have any known allergies?*
  • Are you pregnant?*
  • Does your skin have tendencies to:*
  • Have you used any AHA (alpha hydroxy acids) BHA’s, or glycolics in the last 72 hours?*
  • Are you currently using Retin A, vitamin A, retinol/retinal, tretinoin, or Accutane?*
  • Are you exposed to sun on a daily basis?*
  • Do you have plans to spend more or an extended period of time In the sun soon?*
  • Do you use tanning beds?*
  • Have you ever had a reaction to waxing treatment?*

  • By signing below, you are confirming that you have completed this form, truthfully into the best of your knowledge. Do you agree to inform the aesthetician of any changes in the above information or your medical history. Do you agree to waive all liabilities toward the aesthetician in the employer for any injury, or damage is incurred due to any misrepresentation of your health history.

    By signing below, you also Grant and authorize Face Space by Alyssa LLC or technician the right to take, edit, alter, copy, exhibit, publish, distribute, and make use of any and all pictures videos, and or audio taken to be used in and or for any lawful promotional materials, including, but not limited to newsletters, flyers, posters, brochures, advertisements, press, kids, websites, social media sites, and other print in digital communications, without payment, or any other consideration. 

    This authorization shall continue indefinitely and extends to all languages media formats in market, now known or later, discovered. You waive any rights to royalties, or other compensation arising are related to the use of the photograph or recording.

    By signing below, you understand, and agree that these materials shall become the property of Face Space by Alyssa LLC and will not be returned.

    You here by hold harmless and release  Face Space by Alyssa LLC or technicianfrom all liability, pensions, and causes of action which my ears, representative, executors, administrators, or any other person, may make, while acting on my behalf, or on behalf my estate.

    By signing below I hear by acknowledge that I have completely red and fully understand the above release agreement.

  • Date*
     - -

  • I hear by consent to and authorize The Skin Distillery Esthetics to perform the waxing treatment that were scheduled. 

    please initial each statement below.

  • My signature acknowledge that I have read in agree to receive the treatment or service of treatments listed above or booked, and that I will adhere to all of the aforementioned statements that I have initialed. I fully understand the risks and side effects associated with the treatment. I freely assume these risks and release The Skin Distillery Esthetics and the esthetician of all liability.

  • Date*
     - -
  • Should be Empty: