WAXING CONSENT FORM

WAXING CONSENT FORM
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com
How did you hear about us?*

InstagramGoogleFacebookFamilyFriendWalk In
List any known allergies:*
N/A if none
Emergency Contact*

Full NameCell Number
Our Policies

Please take a moment to complete our consent form. By submitting the form below you agree to knowingly and willingly consenting to our policies and procedures.
24 hour notice is required for any canceled or rescheduled appointment or up to 100% of service price will be charged. Failure to show without notice will require in full payment of service booked. We do not offer monetary refunds on services rendered. We do have a 7-day policy in place on services in which a client can come back and have corrections made provided we are notified of any issues within 24-48 hours of initial service. Client must contact provider within 24-48hours after service rendered of any issues. Fees may apply. By choosing yes, I’m acknowledging I have read, understand, and agree with the terms of these policies.*

Yes
Please check next to any of the following medication or products that you are using:*

AcutaneRetin-ADifferinRenovaBlood ThinnersHigh Antibiotic UseRetinolAdapaleneAlpha-Hydroxy ProductsNone
We advise NOT TO WAX if using certain medications and products that make the skin more sensitive (such as any listed above).
Please list any other medically prescribed topical medications you use for acne control or anti-aging:*
N/A if none
Sensitivity is not limited to these products and I understand that it is my responsibility to bring up any questionable products that I may be using. Dry skin or regular skin sensitivity may cause irritation or tearing of the skin during a waxing service. I also understand that it is my responsibility to inform my technician of any skincare changes I make moving forward.*

Yes
Certain physical conditions such as diabetes, pregnancy and predisposition to cold sores may also cause heightened sensitivity of the skin. Medical procedures such as face-lifts, chemical peels and dermabrasion should be disclosed to the technician. The treatments I receive here are voluntary and I release my technician/salon from liability and assume full responsibility thereof.
Signature*

Clear
Parents must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent/Guardian Signature:

Clear
Should be Empty:

WAXING CONSENT FORM

Our Policies