waxing consent/intake form

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

birthday (mm/dd/yyyy)

click all hair removal methods utilized recently and in the past.

have you taken Retin-A, Renova, Accutane, or any other acne medication in the past 6m-1yr? if yes, when?

do you use any skin-thinning products or blood-thinning medications?

do you regularly use tanning beds and/or expose yourself to the sun?

do you suffer from any allergies? if yes, please list below.

do you suffer from ingrown hairs?

do you consent to take before and after pictures/videos to be showcased on my instagram?

do you prefer to turn it all off when you come get pampered? click “yes” if you would like a silent appointment and have some quiet time.

please be aware that waxing may cause redness, swelling, soreness, and other unpleasant side effects. by signing below, i acknowledge that i have read the preceding material and have answered the questions honestly. i understand that Moon's Wax Room will take all reasonable steps to minimize/eliminate any undesirable reactions.

Signature

waxing consent form