Consultation Form

Would you like to be added to our email list for special discounts?YESNO

Do you have any of the following conditions (check all that apply):

Are you currently being treated for an illness/condition not listed above?YES NO

Have you been or will you be in the sun or tanning bad within 24 hours? YES NO

Have you recieved Botox treatments in the last 72 hours? YES NO

Are you currently pregnant? YES NO

When is your next menstrual cycle start date? Please notify the treatment provider if you are on/within 2 days before or after your menstrual cycle

Are you currently using (circle all that apply):

Igive permission to the esthetician to perform the following waxing procedures (check one or more): Full Leg Upper Lip Full Body Half Leg

/ completed the above form to the best of my knowledge. / have had the opportunity to ask any questions and have received satisfactory answers. / will inform the esthetician of any changes to the above information. / am over the age of 18 and consent to the procedure. If / am under the age of 18, my parent/guardian must sign below. / will not hold the esthetician, salon, or employees liable for any injury or damage that may occur as a result of the waxing procedure or for any issues not disclosed at the time of my service.

THE WAXING PROCEDURES ARE PERFORMED WITH THE PROPER TECHNIQUE, PRODUCTS, AND INSTRUMENTS, AND WITH YOUR SAFETY IN MIND. HOWEVER, THERE STILL ARE SOME RISKS ASSOCIATED

WITH THE PROCEDURE. THIS CONSENT FORM IS INTENDED TO INFORM YOU OF THE RISKS OF THE PROCEDURE AND TO OBTAIN YOUR INFORMED CONSENT FOR THE PROCEDURE.

I understand that an allergic or adverse reaction to the waxing can occur. The symptoms can include, but not limited to, redness, swelling, irritation, itching, bumps, ingrown hairs, bruising, tenderness, and/or skin infection. I understand the effects may be worse for people with sensitive skin or skin conditions.

I agree to seek medical attention at my own expense if necessary.

I agree to notify the esthetician of any retinol products I am currently using, including but not limited to Accutane and Isotretinoin.

I understand that waxing is not permanent hair removal, and the hair will grow back.

I understand that results of the procedure may vary and my final result may not be what I initially envisioned.

I will notify the esthetician if my appointment is within 2 days of my menstrual cycle starting or 2 days after the cycle ends.

Iagree to the home aftercare procedure recommended by the esthetician.

/ completed the above form to the best of my knowledge. / have had the opportunity to ask any questions and have received satisfactory answers. / understand the risks and potential side effects associated with the waxing procedure. / am over the age of 18 and consent to the procedure. If / am under the age of 18, my parent/guardian must sign below. / will not hold the esthetician, salon, or employees liable for any injury or damage that may occur as a result of the waxing procedure or for any issues not disclosed at the time of my service. This agreement remains in effect for this procedure and any follow-up appointments.

Parent/Guardian Signature: (if under 18)