Waxing Waiver Form
Name
*
First Name
Last Name
Email
*
example@example.com
Who referred you?
*
Phone Number
*
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you over 18?
*
Have you used any Alpha Hydroxy Acids (AHA) or glycolic products in the past 48-72 hours?
*
Yes
No
Have you used Retin-A, Renova, or Accutane within the past year?
*
Yes
No
When?
-
Month
-
Day
Year
Date
Are you using any other skin thinning products and/or drugs that thin the blood?
*
Yes
No
Do you use tanning beds and/or are exposed to the sun on a regular basis?
*
Yes
No
Are you currently taking any medications? If so, please list.
*
Please list any illness/conditions which ou are currently being treated for by a medical professional.
*
Do you have any open skin lesions?
*
Yes
No
Do you have any allergies?
*
Yes
No
Please list your allergies
*
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 and if I have any concerns, I will address these with Lash Beauty Asthetics. I give permission to Lash Beauty Aesthetics to perform the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment. I agree to adhere to all safety post care including: no peels, tanning, or wet room services; no swimming/spas/hot tubs for 72 hours after waxing; and all home skin care protocols as recommended by my service provider. I understand that Vi Beauty Esthetics will take every precaution to minimize or eliminate negative reactions as much as possible.
I understand that Lash Beauty Aesthetics will take every precaution to minimize or eliminate negative reactions as much as possible.
I agree to stop using anything potentially irritating like toners, exfoliators at least 1 week before and 3 to 4 days after the hair has been waxed. Refrain from the use of retinols, aha/bhas, glycolic or salicylic acid or any other form of topical chemical exfoliants for at least 2 weeks before wax appointment. Any of these products can cause skin lifting/skin burning.
Date
*
-
Month
-
Day
Year
Date
Signature
*
Submit
Should be Empty: