Waxing Consultation Form

  • Waxing Consultation Form

  • Date*
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  •  -
  • Date of Birth
     - -
  • How did you hear about us?

  • Contraindications requiring medical permission

    If medical permission cannot be obtained, the client must give written informed consent prior to treatment.
  • Please select the condition/s that apply to you.*

  • Contraindications that restrict treatment

    It is NOT recommended for you to go ahead with the appointment if you have any of the following contraindications.
  • Please select the condition/s that apply to you.*
  • Area/s being waxed
  • Have you been waxed before?
  • Are you taking birth control?
  • Are you pregnant or trying to become pregnant?
  • Any menopause issues?
  • Are you undergoing any hormone replacement therapy?

  • I GIVE PERMISSION TO MY AESTHETICIAN, ANGELA AT BARE AND NEUTRAL LTD, TO PERFORM THE WAXING PROCEDURE I HAVE CHOSEN. I FULLY UNDERSTAND THE QUESTIONS I HAVE BEEN ASKED AND I HAVE ANSWERED THEM ACCURATELY. I KNOW THAT BRUISING, SKIN LIFTING AND INGROWN HAIRS CAN OCCUR AS A RESULT OF WAXING. I UNDERSTAND ANY FALSE INFORMATION GIVEN MAY LEAD TO UNDESIRED RESULTS AND COMPLICATIONS AND MY AESTHETICIAN, ANGELA AT BARE AND NEUTRAL LTD, WILL NOT BE HELD RESPONSIBLE. I KNOW THAT IT IS MY RESPONSIBILITY TO ALERT MY AESTHETICIAN, ANGELA AT BARE AND NEUTRAL LTD, ABOUT ANY RECENT SURGERIES OR SKIN RESURFACING PROCEDURES AS WELL AS ANY MEDICATION I AM TAKING THAT MAY AFFECT THE PROCESS. I UNDERSTAND WAXING CAN CAUSE REDNESS, IRRITATION, PIMPLES AND BUMPS. I UNDERSTAND THAT MY AESTHETICIAN, ANGELA AT BARE AND NEUTRAL LTD, WILL TAKE EVERY PRECAUTION TO MINIMISE, ELIMINATE AND/OR PREVENT NEGATIVE REACTIONS AS MUCH AS POSSIBLE. I WILL HOLD MY AESTHETICIAN, ANGELA AT BARE AND NEUTRAL LTD, HARMLESS FROM ANY LIABILITY THAT MAY RESULT FROM THE TREATMENT I HAVE CHOSEN.

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