WAXING INTAKE FORM

Name

First NameLast Name

Birthdate

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Are you 18 years or older?

How did you hear about us?

Other

Referral Name:

First NameLast Name

Have you been professionally waxed before?

If yes, how long ago was your last wax?

For intimate services, your comfort is my priority. Are there any concerns over triggers you'd like me to be aware of? (Optional & confidential)

List all allergies and/or skin sensitives.

Please list N/A if no known illnesses/conditions are to be listed.

Do you have a tendency to experience...(Select all that apply)

Have you ever had a reaction from a product or hair removal service? If yes, please list:

"NONE" If not applicable.

Do you have any of the following conditions? (Select all that apply)

Please list any other illness/conditions you are currently being treated for by a medical professional:

Please list N/A if no known illnesses/conditions are to be listed.

Are you currently taking medications? If so, please list all (including over the counter drugs/herbal supplements):

Please list NONE if no medications are being taken.

Have you had a Chemical Peel, Microdermabrasion facial, Hydrodermabrasion facial, Botox or any other beauty treatment in the last 2 weeks? If so, please schedule wax for 30 days after treatment.

Have you used any AHA, salicylic acid, glycolic acid, exfoliating products or rubbing alcohol on your skin in the past 48-72 hours? If so, please book wax 7-10 days after using any products listed.

Are you using Retin-a, Renova, or Accutane (an oral form of Retin-a)?

Are you using any other skin thinning products and/or drugs?

Are you exposed to the sun on a daily basis or are you considering spending more time in the sun soon?

Do you use a tanning bed?

Are you currently Pregnant?

What skin products do you regularly use on your skin?

If none please list NONE.

Do you allow the Esthetician to take photographs or videos of your service for social media/business promotion purposes? Your face and name will not be associated with these when posted. (Examples: Before after under arm wax, eyebrow wax, leg wax, your waxer performing the service. Intimate areas not included)

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 are 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 notify the esthetician of any retinol products I am currently using, included but not limited to Accutane and Isotretinoin. I understand that waxing is not permanent hair removal, and the hair will grow back. PRINT FULL NAME TO SIGN:

POLICY:

To maintain the highest level of service and availability for all clients, please review and acknowledge the following policies prior to booking. Cancellations or reschedules made within 72 hours of the scheduled appointment will result in a charge of 50% of the remaining service balance. Same-day cancellations, no-shows, or arrivals more than 7 minutes late will be charged 100% of the service price. All deposits are non-refundable and may be transferred one time only to a rescheduled appointment when the change is made more than 72 hours in advance. A deposit is required when rescheduling any pre-booked appointment, and appointments canceled or rescheduled within 72 hours will require a new deposit to secure a future booking. Accepted payment methods include cash (preferred, exact change) and credit/debit cards. All sales are final, no refunds will be issued, and only one promotional offer may be used per visit. By booking, you consent to receiving promotional emails and text messages.

Date

I have filled out this form to completion to the best of my knowledge and I give full permission/ consent to the wax specialist to perform the waxing procedure that I book for. Please date & sign below.