Waxing Consent Form

Waxing Consent Form

Please fill out this form prior to your appointment. Failure to do so will result in your appointment being cancelled.
Name*

First NameLast Name
Email*
example@example.com
Date of Birth*

MonthDayYear
Date of Birth
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
AccutaneRetin A or RetinalClindamycinDifferinIsotretinoinTetracyclineBlood ThinnersAdapaleneTretinoinNone
Are you currently on any medications ? *
Do you have any allergies ?*
YesNo
PRECAUTIONS & CONSIDERATIONS:
- Sunburned, irritated, and/or open skin cannot be waxed.
- Moles cannot be waxed.
- You must wait a minimum of seven (7) days before waxing after a light chemical peel or Microdermabrasion.
- Waxing cannot be performed if you have been in a tanning booth the same day.
- Waxing cannot be performed if you have had laser skin resurfacing within the past 12 mos.
- Waxing cannot be performed if you have had a physician-administered peel within the past two (2) years.
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. If I have any concerns, I will address them with my Esthetician prior to the service. I give permisssion to my Esthetician to perform my waxing procedure as discussed, and will not hold the Esthetician or Brazen Aesthetics accountable for any liablity that may result from this treatment. I agree to adhere to all post care instructions including: no peels, tanning, hot tubs, saunas and pools for 72 hours after waxing and all home after care protocals 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.
Signature
Date

MonthDayYear
Date
Should be Empty:

Waxing Consent Form

PRECAUTIONS & CONSIDERATIONS: