Esthetician/Waxing Consent Form

Client Name

First NameLast Name

Date of birth

Date

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Esthetician's Name

First NameLast Name

Please take a moment to answer the following questions

Are you presently taking any medications?

Please list

Are you pregnant?

Do you have any allergies to cosmetics, food or drug?

Please specify

What skin care products do you currently use?

Please specify

Have you had skin cancer?

Do you use acne medication?

Are you taking oral contraceptives?

Please check if you are affected by or have any of the following

I agree with

If I experience any pain or discomfort during the session, I will immediately inform the esthetician so that the products and/or technique may be adjusted to my level of comfort.

I further understand that facial should not be construed as a substitute for medical examination, diagnosis, or treatment.

I understand that estheticians are not qualified to perform, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such.

I agree to keep the esthetician updated as to any changes in my medical profile during the session and understand that there shall be no liability on the estheticians part should I fail to do so.

I understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session.

Also I understand that;

The services offered are not substitute for medical care, and any information provided by the therapist is for educational purposes only and not diagnostically prescriptive in future

Cancellation Policy:
A cancellation or request to reschedule an appointment made less than 12 hours in advance will invoke a cancellation fee. The amount charged will be equal to 50% of the booked services. Should you be more than 10 minutes late for your appointment I cannot guarantee that you will be able to be seen for the service and will have to be rescheduled. If you no call no show for your appointment there will be a 50% charge of services booked.
In the case of a true unforeseen emergency (work, sick, family emergency, childcare) the cancellation fee will be waved up to 3 times.
I understand that life happens, I just request that when you need to cancel your appointment please do so 12 hours in advance. If the appointment was made the same day I ask that you cancel at least an hour before the time of the appointment.
Cancellations that do not meet the above requirements will result in a 50% charge of the service fee.

Client Signature

Date