Femme Lab Esthetics Consent Form

  • Guest Consultation & Consent

    Please fill out completely and honestly. Must be completed prior to receiving service.
  • Browse Files
    Cancelof
  •  -
  • Have you had a wax before?*
  • Have you ever had any issues with your previous waxes?*
  • Have you had a facial before?*
  • Have you ever had any issues with your previous facial?*
  • What are your specific skincare concerns?*

  • Give us an idea of what you typically use on your skin daily?*

  • Have you been diagnosed with eczema, psoriasis or rosacea?*
  • The following products can make your skin more sensitive. Thin, sensitive skin is more vulnerable to lifting and sensitivity during waxing. Are currently using any products that contain:*
  • Do you currently have any rashes, itching or underlying redness on your face, bikini or any other any you’ll be receiving service?*
  • Have you received chemical peels, laser services, or microdermabrasion treatments?*

  • Medical History

  • Are you currently using any of the following prescription medications?*
  • Any known allergies?*

  • Have you ever experienced claustrophobia?*
  • Have you ever experienced vertigo or issues laying flat?*
  • Have you experiences any of these health conditions in the past or present?*

  • Are you currently pregnant or breast-feeding?*

  • Acknowledgment and Waiver

  • Esthetic skin care is not an exact science. Each individual’s medical history, lifestyle and skin behaves differently, therefore there's no way to guarantee a specified result or guarantee freedom from adverse side effects. Femme Lab Esthetics will take all possible precautions to avoid such complications. It is therefore imperative that you disclose all of your information candidly so that your treatment can be altered to help avoid complications.

    Adverse side effects of facials and waxing include but are not limited to: swelling of the face, redness of the treated area, blistering of the skin, crusting of the skin, scars, infection, cuts and burns, change of pigmentation of the skin, and allergic reaction to the products used.

    I have had the opportunity to ask my esthetician any questions I may have. I understand this is a cosmetic procedure with risks and potential side effects, and I voluntarily wish to have the services provided with knowledge of the potential side effects. I understand that any false information I have provided may lead to undesirable consequences and affirm I have truthfully discussed my personal and medical history to my esthetician. I further understand my failure to follow post care instructions may also lead to undesired results, complications or effects. I understand that the esthetician does not diagnose illness, disease, or any other physical or mental conditions. To the maximum extent allowed by law, I agree to waive and release any and all present and future claims, suits or related causes of action against Femme Lab Esthetics and its service providers.

    I have read the above information and if I had any concerns, I have addressed them with my esthetician. I give permission to my esthetician to perform the procedure we have discussed and will hold them harmless from any liability that may result from this treatment. I have given an accurate account of all known allergies or prescription drugs and products I am currently ingesting or using topically.

    This waiver will be kept on file and will apply to each and every service I receive today and in the future. By signing this document state that I have read, agree and understand the terms herein and voluntarily have accepted the service and any potential risks that may be associated with the service.

  • Should be Empty: