Brow Wax/Mapping Consent Form

Full Name*

First name Last name

Cell Phone Number*

Format: (000) 000-0000.

Date of Birth

Date

Age?

Have you ever waxed?*

No, neverYes

Are you currently using or taking any of these ?*

Do any of the following apply to you ?*

List any medical conditions you may have (if applicable)*

If any or just put none.

If you have any allergies please state what you are allergic to:*

Examples: latex, lidocane, fragance, fruits, essential oils/suncreen, fruits etc..

Have you ever been diagnosed with eczema, psoriasis, rosacea*

YesNo

Are you currently pregnant or breastfeeding?*

YesNo

Any additional information you would want me to be aware of ?

*Photography* I use the instagram @_browsbyclaudia for promotional purposes, do you consent to photos/videos during your services?

YesNo

By signing below you have agreed to the following:

I understand, have read and completed this form truthfully. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, and products containing acids 7 days before treatment. I consent to completing this form to the best of my knowledge and agree to inform the technician of any changes to the information above. I have now been informed and understand the contradictions to the requested treatments and agree that I do not have any condition(s) that would make the requested treatment unsuitable. I confirm and agree that I wish to engage the services of _browsbyclaudia,to perform the brow wax procedure on myself. I understand the procedure and accept the risks. I do not hold Browzbyclaudia responsible for any conditions that were present before or after service.

Sign date *

Date

Client signature *

Brow Wax Consent Form (Brow wax/Mapping)

Please complete the following information,Medical History: