WAXING CONSULTATION FORM
*New Client*
Name
*
First Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
What waxing service would you like to do?
*
Upper Lip
Sideburns
Chin
Underarms
Arms
Legs
Chest
Back
Brazilian
Bikini
Butt Strips
Buttocks
Other
Choose an appointment date and time
*
Are you currently taking any medications?
*
Yes
No
What are the medications you're currently taking and what is their purpose?
Do you have any allergies?
*
Yes
No
Please list down your allergies below (e.g. seafood allergy, penicillin-based antibiotic allergies)
Are you pregnant?
*
Yes
No
Please check below if you have the following tendencies:
Rows
Yes
No
Remarks
Scarring
Hyperpigmentation
Ingrown Hairs
Bumps
Bruising
Skin Disorder
If other please state in remarks column
Have you had a wax before?
Yes
No
Emergency Contact (Name/Number)
Acknowledgement
*
I acknowledge that I have disclosed any relevant health conditions or skin sensitivities to the waxing technician.
I understand that a consultation will be conducted before my waxing service to address any concerns and determine the appropriate treatment.
I agree to follow the aftercare instructions provided to me to ensure the best results and minimize any potential irritation.
I acknowledge that waxing may cause discomfort and that pain tolerance varies from person to person.
I understand and agree to the cancellation policy, which requires me to notify the business at least 24hrs in advance of any appointment changes.
I consent to the use of my before-and-after photos for promotional purposes, unless I specify otherwise.
I agree to pay for services rendered at the time of my appointment and understand the payment methods that were accepted.
I acknowledge that I release the waxing business and its employees from any liability for injuries or reactions that may occur as a result of the waxing service.
I confirm that I have read, understand, and answered this consultation form accurately to the best of my knowledge.
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
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