Women’s Wax Consent

Wax Consent Form - Women

Thanks for booking with KB Wax & Beauty Bar. Please fill out this form at least 24-48 hours before your scheduled appointment.
Full Name

First NameLast Name
Parent’s Name if filling out for a minor

First NameLast Name
Phone Number
Format: (000) 000-0000.
Birthday

MonthDayYear
Date
E-mail
example@example.com /
Do you consent to have promotional messages such as coupons and follow ups sent by text or email?
How did you hear about us?
If you chose referral or other, specify the person or place.
What services will you be receiving today?
When did you last shave, nair, or get waxed? Hair has to be at least the length of a grain of rice.
What are you expectations from this service?
Have you used the following on the last 48-72 hours?

Other
Do you have braces or metal implants ?
Do you have heart disease or pacemaker?
Do you have the following? All information in this document is protected by HIPPA

Other
Do you have/prone to

Other
PLEASE LIST ALLERGIES
If you were aware of an allergy and did not disclose, KB Wax & Beauty Bar is not responsible for reactions.
If you're on any acne medication (due to increased skin thinning causing skin to lift more easily) or diabetic, broken capillaries, AIDS/HIV (due to proneness to injury and infection) it's recommended you do not get waxed by signing this form you acknowledge this statement.
If you are experiencing an outbreak. Please reschedule. We will not wax over broken or blistered skin.
I understand that being on or near my cycle will increase sensitivity. In the event that I start my cycle I have the option to either reschedule or wear a tampon/menstrual cup to my appointment.
I understand that intimate waxing can cause some stimulation & unwanted arousal. In the event that I start to get over stimulated/aroused, I will immediately let my service provider know. I understand that my service provider will stop the service, step out of the room, & and give me at least 1-2 minutes to adjust.
You may experience skin sensitivity|thinning which can result in skin lifting from the following : Pregnancy, Sunburn, Sensitive skin, Retinol,Antibiotic, Menstruation, Certain Medical Conditions, Other Medications not listed.
I am over the age of 18. If under the age of 18 an adult will have to accommodate you and sign for you
Do you consent to before/after pictures being taken?
Preferred artist or genre of music you would like to hear during your service?
I have read and agree to the policies when booking with KB Wax & Beauty Bar.
If you have not read the policies please take the time to do so. Answering no to the above question will result in appointment being cancelled.
SIGNATURE REQUIRED

Please note that waxing does have certain side effects such as skin removal, redness, swelling, tenderness, etc. I have read the above information and if I have any concerns, I will address these with my skin therapist. I give permission to my therapist to perform the waxing procedures we have discussed and will not hold her and her staff liable from any harm/reaction that may result from this treatment. I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. I have read and understand the post-treatment home care instructions. I am willing to follow recommendations made by my esthetician for an at home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product / post-treatment care, I will consult the esthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the esthetician, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.
Signature
Date

MonthDayYear
Date
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