Waxing Consent Form : Client information

Waxing Consent Form : Client information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
How did you hear about us ?
Have you used any Alpha Hydroxy Acid (AHA) or glycolic products in the past 48-72 hours?
Are you using Retin-a, Renova or Accutane (an oral form of Retin-a)?
Are you using any other skin thinning products and/or drugs?
Do you use a tanning bed?
Are you diabetic?
Are you currently taking medications? If so, please list all (including over the counter drugs/herbal supplements)
Please list any other illness/condition you are currently being treated for by a medical professional
Are you okay with before/ after photos or videos to use for online portfolio? ( photo will be anonymous)
If you are currently using any of the following medications,you cannot be waxed today:

* Accutane, Renova, Tretinoin, Adapalene, Allistra, Avage, Isotretonoin, Anita, Differin, Retin-A, Tazarotene *

You may experience skin sensitivity/thinning, which can result in skin lifting from the following:

* Sunburned skin * Pregnancy * Retinol * Antibiotics
Client Name (Signature)
I, blanks authorize
blank to receive a waxing treatment on
Parent/Guardian Consent (under 18 years old)
Date

MonthDayYear
Date
Should be Empty: