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Waxing Consent Form
Consent form for waxing
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1
Name
First Name
Last Name
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2
Date of Birth
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Year
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Have you used any Alpha Hydroxy Acids (AHA) or glycolic products in the past 48-72 hours?
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No
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Have you used Retin-A, Renova, or Accutane within the past year?
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When?
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Are you using any other skin thinning products and/or drugs that thin the blood?
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7
Do you use tanning beds and/or are exposed to the sun on a regular basis?
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Are you currently taking any medications? If so, please list.
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Have you been treated for cancer? If yes, when and what types of therapies were used?
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Please list any illness/conditions which ou are currently being treated for by a medical professional.
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11
Do you have any open skin lesions?
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Do you have any allergies?
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Please list your allergies
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Please note that waxing can have certain side effects such as skin removal, redness, swelling, tenderness, etc.
I have read the above information and have given an accurate account of the questions and if I have any concerns, I will address these with my Esthetician. I give permission to my Esthetician to perform the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment. I agree to adhere to all safety post care including: no peels, tanning, or wet room services; no swimming/spas/hot tubs for 72 hours after waxing; and all home skin care protocols as recommended by my service provider. I understand that my Esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.
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Date
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