Waxing Consent Form

Customer Name

First NameLast Name

Customer Email

example@example.com

Customer Phone Number

Area CodePhone Number

Age

Gender

Please answer the health and skin checker for the safety of the procedure:

	Yes	No	N/A	Remark
Have you done any waxing before?
Are you currently taking any medications?
Have you had any skin thinning treatments before?
Are you Pregnant? (Female)
Do you have sensitive skin?
Do you have skin allergies?
Do you bruise easily?
Are you prone to scarring and hyperpigmentation?
Have you had any recent chemical peels, laser treatments, or exfoliation procedures in the treatment area?
Do you have a history of skin conditions such as eczema, psoriasis, or rosacea?
Have you recently been exposed to prolonged sun exposure or used tanning beds?
Do you have any open cuts, wounds, or skin infections in the area to be treated?
Have you had any previous adverse reactions or complications from similar procedures?
Please refrain from using deodorant before or after an underarm wax.

Are you currently using any cosmetic products that may contain the following substance? Kindly check if yes and if no, leave it blank.

Waxing Procedure Explanation:

I understand that waxing involves the removal of hair from various parts of the body using hot or cold wax. I have been informed about the areas to be waxed and the expected results of the procedure.

Risks and Precautions:
I acknowledge that waxing may carry certain risks, including but not limited to temporary discomfort, redness, skin irritation, allergic reactions, burns, bruising, ingrown hairs, or infection. I understand that it is my responsibility to inform the esthetician about any allergies, skin conditions, or medications that may affect the waxing process.

Personal Hygiene:
I affirm that I have maintained proper personal hygiene by showering or bathing prior to the waxing appointment. I understand that this is important to ensure a hygienic and effective waxing procedure.

Skin Sensitivity and Reaction:
I am aware that every individual's skin may react differently to waxing. I understand that if I experience any unusual or adverse reactions following the waxing procedure, it is my responsibility to inform the esthetician immediately.

Precautions and Aftercare:
I have been provided with pre-waxing and post-waxing care instructions. I understand the importance of following these instructions to minimize the risk of complications and to achieve the best results. I will avoid sun exposure, excessive heat, exfoliation, and the use of harsh products on the waxed area as advised.

Release of Liability:
I release Lyna’s Wax Bar, LLC, its employees, and estheticians from any liability or claims arising from the waxing procedure, except in the case of negligence or intentional misconduct.

Photographs and Testimonials:

I grant Lyna’s Wax Bar, LLC permission to use photographs taken during or after the waxing service for promotional purposes, including but not limited to the salon's website or social media platforms. I also give consent for providing testimonials about my experience, which may be used for marketing purposes. If I wish not to, it must be in writing or verbal agreement.

I am providing my consent to complete the procedure I am requesting for I am duly aware of the side effects of waxing to my skin during or after the procedure such as:
skin redness, swelling, skin irritation, bruises, or bumps.

I acknowledge and completed health and skin checker, efficiency, and accuracy.

I was instructed and enlightened that some cosmetic additives or chemical substances itemized were hazardous when coupled with waxing and may most likely cause disappointing results and side effects to my skin area.

I hereby affirm that I have read and fully understand the above, am over eighteen years of age and am legally liable for my own decisions/actions.

By signing below, it means that I agreed to the terms indicated in this document. I have confirm that I have been given the opportunity to ask questions and have received satisfactory answers regarding the waxing procedure. Lastly, I voluntarily consent to undergo the waxing procedure.

Customer Signature

Date Signed

Date

Lyna's Wax Bar Waxing & Facial Consent Form

Waiver Consent