• Waxing Consent Form

  • Format: (000) 000-0000.
  • Have you been waxed before*

  • The following are potential contraindications for waxing :

  • Any chemical exfoliation treatment such as glycolic acid peel or any other AHA treatment? (must wait at least 2 weeks before waxing)*
  • Applied any topical products containing AHAs (glycolic or lactic acid), BHAs (salicylic acid), or lightening or bleaching gels? (must wait at least 48 hours, a week is preferred)*
  • Are you on any blood thinners?*
  • Are you taking any acne drugs and/or using exfoliating topical products such as Retin-A® or other vitamin A products? (must wait at least 3 months or longer depending on drug)*
  • Have you had microbrasion, laser resurfacing, light therapy, or injectable treatments? (must wait 4 weeks or longer depending on treatment)*
  • Are you diabetic?*
  • Exposure to continuous sun, or shaved, scrubbed, or experienced any recent peeling or irritation in the last 48 hours?*
  • Have you taken Accutane in the last year?*
  • Are you taking any medications that make you photosensitive?*
  • Do you frequent tanning beds?*
  • Do you currently have a sunburn?*
  • Do you currently have or have had any of the following medical conditions that could compromise your skin and/or services being offered:*

  • If you are using any of the following medications, you can not be waxed today

    Accutane, Renova, Tretinoin, Adapalene, Alustra, Avage, Isotretinoin, Avita, Differin, Retin-A, Tazarotene

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

    Sunburned skin, Retinol, certain medical conditions, pregnancy, antibiotics, other medications not listed, menstruation

  • I understand that topical creams,medical conditions, and medications can affect the results of waxing. I understand that I cannot be waxed if I have certain contraindications such as taking topical acne drugs or if I'm using Retin-A (or any other peeling agents close) topical prescription products.

    I understand that I am accepting full responsibility for skin reactions if I do not inform my technician of contraindications prior to waxing.

    Certain medications products and treatments use prior to my waxing may result in irritation, skin peeling, blotchiness, pigmentation, and sensitivity.

    I understand that some redness and or sensitivity may result. I agree to avoid sun exposure assessive heat (saunas, hot tubs) and all active products for the next 48 hours as instructed by the technician.

    The hair removal process has been explained and I have had an opportunity to ask questions and receive satisfactory answers.

    I consent to be waxed and will not hold Glow & Ink Aesthetics LLC, or technician responsible for any adverse reactions from treatments or products.

    By signing below, I verify that I have read and understand the above statements and agree to them.

  • Date*
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