Client Consent: Waxing

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Client information
First and Last Name
Phone number
Email
Birthday mm/dd
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Emergency contact
Name
Phone number
Relation
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Do you have any allergies to wax, latex, or skincare products?If yes, please specify in additional notes
YESNO
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Are you currently taking any medications, including topical or oral prescriptions?(e.g retinoids, Accutane or blood thinners)
YESNO
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Do you have any skin conditions such as eczema, psoriasis, rosacea, or hypersensitivity?If yes, please specify in additional notes
YESNO
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Have you recently used any exfoliating or resurfacing products. (e.g glycolic acid, salicylic acid, or retinol)If yes, please specify in additional notes
YESNO
7
Are you pregnant, nursing, or experiencing any hormonal changes that may affect your skin sensitivity?If yes, please specify in additional notes
YESNO
8
Do you bruise easily or have a history of poor healing, such as scarring or hyperpigmentation?If yes, please specify in additional notes
YESNO
9
Have you been diagnosed with or are currently undergoing treatment for cancer (e.g., chemotherapy, radiation, or other medical therapies)?If yes, please provide relevant details in additional notes
YESNO
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Please share anything else you’d like your esthetician to know.
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Have you ever been waxed before?
YESNO
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Have you had any reactions or complications from waxing or hair removal in the past?If yes, please specify in additional notes
YESNO
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Have you recently undergone the following treatments in the area to be waxed?If other, please specify in additional notes
Chemical peels
Laser treatments
Microdermabrasion
Botox/Filler
Other
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Do you have any of the following in the area to be waxed?If yes, please specify in additional notes
Sunburn
Rashes or irritation
Cuts, wounds, bruises
Active acne or infections
Other
No
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Do you have any moles, birthmarks, or other sensitive areas that should be avoided during waxing?If yes, please specify in additional notes
YESNO
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Are you currently using any exfoliating or resurfacing products (e.g., retinol, AHAs, BHAs, or acne treatments) in the area to be waxed?If yes, please specify in additional notes
YESNO
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Have you done or been exposed to any of the following in the past 48-72 hours?If you have additional details, concerns, or other exposures not listed, please specify in additional notes
Excessive Sun Exposure or Tanning
Saunas, hot tubs, or steam rooms
Exfoliating Products or Treatments
Chemical Treatments
Medications
Facial treatments
Active ingredient skincare
Laser treatments or skin resurfacing
Injectable treatments
Other
No
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Please list additional notes:
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Post-waxing care •Avoid Sun Exposure: No tanning or direct sun for 48-72 hours. •No Heat or Sweating: Avoid hot showers, saunas, and strenuous exercise for 24-48 hours. •Keep the Area Clean and Moisturized: Use a mild, fragrance-free soap and apply a soothing, fragrance-free moisturizer. •Don’t Touch or Scrub: Avoid touching, picking, or scrubbing the waxed area to prevent irritation and infection. •Wear Loose Clothing: Refrain from tight clothing that can rub against the treated area. •No Harsh Products: Do not use products with alcohol, fragrances, or strong chemicals on the waxed area. •Exfoliate Gently After 48 Hours: Use a soft exfoliator to prevent ingrown hairs. •Use Ingrown Hair Serum: Consider applying a post-waxing serum to prevent ingrown hairs, especially on sensitive areas like the bikini or underarms. •Avoid Chlorine or Saltwater: Stay out of pools, hot tubs, or the ocean for 24-48 hours to prevent irritation. •Apply SPF: If exposed to the sun, apply a broad-spectrum sunscreen (SPF 30 or higher) on the waxed area. By continuing, you agree to follow these aftercare instructions to ensure the best results.
Please Select
Please Select
I agree
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Please note that waxing may have certain side effects such as redness, swelling, skin removal, tenderness, etc.
I have read the above information and if I have any concerns, I will address these with my esthetician. I give permission to my esthetician to perform the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment. I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.
I have read and understand the post-treatment home care instructions. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product / post-treatment care, I will consult the esthetician immediately.
I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the esthetician responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.
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Date
Date
Month
Day
Year
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Signature
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