Wax, Tint, Lamination Consultation Form
Location
*
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SEBRING - 121 S COMMERCE AVE SEBRING, FL 33870
MIAMI - 8500 W FLAGLER STSUITE 106AMIAMI, FL 33144
Name
*
First Name
Last Name
Phone Number
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Please enter a valid phone number.
Email
*
example@example.com
Date of Service
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Month
-
Day
Year
Date
Have you had a Chemical or Laser Peel within 6 weeks? If so, you are unable to wax.
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Yes
No
Have you taken Accutane in the last year?
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Yes
No
Have you used a Retinoid, Retin-A, Differin, Renova, Benzoyl Peroxide, Salicylic Acid, Tretinoin or similar in the last 14 days? If so, which one?
*
If none, put NA
Please upload a photo of your eyebrows without make up using the back camera of your phone and flash/natural lighting.
*
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Liability Release
I consent to the waxing services provided by MONT. ESTHETICS, LLC. (referred to as "The Esthetician". Iunderstand the potential risks associated with waxing, including but not limited to temporary discomfort and skin irritation, skin redness, or allergic reactions to wax or other products used, I agree to follow all post-waxing care instructions provided by the esthetician to reduce the risk of adverse reaction and maintain the best results.Esthetician to reduce the risk of adverse reactions and maintain the best results.I release the Esthetician from any liability for any adverse reactions, injuries, or damages that may occur as a result of the waxing treatments) provided. I understand that it is my responsibility to provide accurate and complete information about any health or medical conditions, allergies, or medications I am currently taking that may affect my waxing treatment.The Esthetician reserves the right to refuse service for any reason deemed appropriate, including but not limited to behavior that is disruptive, disrespectful, or poses a risk to the safety and well-being of staff and other clients.I release MONT. ESTHETICS, LLC. from all liability associated with this procedure. There are no guarantees for the bonding time length of the eyelash extensions. I understand that I have been advised to follow the aftercare protocol from my technician to avoid any discomfort or adverse side effects after the procedure has been completed.
Social Media Release
I (the Client) give my consent to MONT. ESTHETICS, LLC. (the Business) to use my photographs for promotional purposes on flyers and/or social media platforms including, but not limited to Instagram, Facebook, and TikTok.
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I acknowledge that I confirm I am either at least 18 years old or accompanied by a legal guardian & I have read, understood, and agreed to the terms and conditions outlined in this Agreement.
Client's Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Please upload photo ID
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