Facial Form

Name

First NameLast Name

Phone Number

Format: (000) 000-0000.

Date of Birth

Date

Address

Street Address

Street Address Line 2

CityState

Zip Code

Emergency Contact Name & Phone Number

How did you hear about wAxxd studio & aesthetics?

Have you had a facial before?

What are your specific skincare concerns?

What do you typically use on your skin daily?

Any known allergies?

Have you ever been diagnosed with eczema, psoriasis or rosacea on the face?

Are you currently using any products that contain:

Do you currently have any rashes, itching or underlying redness on your face?

Please list medications or supplements you are currently taking.

Have you ever received chemical peels, laser services, or microdermabrasion treatments?

Have you had botox in the past 7 days?

Have you had fillers in the past 14 days?

Are you pregnant or breast-feeding?

Acknowledgement and Waiver

I hereby agree to have this treatment be performed on me. I am aware that there is a remote chance of an allergic reaction and there is a possibility of an adverse reaction to product used in facials.

I am also aware that certain services should not be performed with certain medical conditions. I have disclosed all my known medical conditions, allergies, medications and answered all questions honestly on the above form and agree to update WAxxd Studio & Aesthetics as to any changes.

I acknowledge that the esthetician at WAxxd Studio & Aesthetics do not provide medical advice and I accept full responsibility to seek out such advice before receiving any services or products from WAxxd Studio & Aesthetics I hereby release, discharge and waive any and all claims against WAxxd Studio & Aesthetics and esthetician performing services or applying any products at WAxxd Studio & Aesthetics, including from liability and responsibility for any and all illness, injuries, damages, claims, rights and causes of action of any kind or nature, that may occur during or arising out of any services or products received on this and any future dates. I expressly assume and accept the risk for any injuries sustained. I have read this entire document and agree to its terms.

Signature

Everyone's time is valuable; Therefore, I have the following policies in place:

CANCELLATION POLICY:
Cancellations made within the 24-hour window will incur a 50% charge of the service fee to the client's card on file.

NO SHOW POLICY:
This is a zero-tolerance policy! No-show appointments will incur a 100% charge of the service fee to the client's card on file.

LATE POLICY:
I allot 10 minutes past the scheduled appointment time for clients that may be running behind. This helps to ensure I stay on time for all the appointments to follow. If it has reached 10 minutes after the scheduled appointment time, I will need to reschedule the appointment and you will be charged 40% of the service.

RESCHEDULING POLICY:
Similar to cancelling the appointment; The client will be charged a fee to reschedule if it is within the 24-hour window. The rescheduling fee will be $30.00 and an additional $15 hold fee to go towards rescheduled appointment. If the rescheduled appointment has to be cancelled a second time within the 24-hour window there will be a 50% charge of the service fee. If cancelled a third time client will automatically be charged the full amount of service fee and no longer be able to schedule appointments with me.

Please Note:
Shall any of the charges not be fulfilled, the client will no longer be allowed to book future appointments until payment is received.
Failure to follow my policies or multiple violations will result in restrictions to booking and possible termination of my services.

Signature

Facial Intake Form

Your Skin

Female Clients