Waxing Consultation/Consent Form

Name

DOB

Age

Address

Phone

Occupation

Email

example@example.com

How did you hear about us?

InstagramFacebookFriend (type their name below for us to say thank you!)Other

Have you ever had a reaction to a waxing service?

YesNo

If yes please describe

Do you have any allergies/sensitivities? (such as tea tree, etc.)

YesNo

If yes please describe

Do you have varicose veins on your legs?

YesNo

Have you ever had a Brazilian wax?

YesNo

Do you use glycolic, salicylic, lactic acid or any other acid-based products on your face or body?

YesNo

Have you had recent microdermabrasion, laser resurfacing or injectable fillers?

YesNo

Are you taking acne medication or vitamin-A products (such as accutane)?

YesNo

Do you consent to any photos/videos to be taken for purposes of educational material, marketing, promotions, etc? (By consenting you agree to no financial compensation in the future or present)

YesYes, unless it is a brazilian waxNo

Have you or will you be in the sun or tanning bed within 24 hours of this treatment?

YesNo

By signing below, I understand that topical creams, medical conditions, and certain medications can affect the results of waxing. I understand that I can not be waxed if I have certain contraindications and I hereby release "Lush Skin Studio" harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act, or misinformation both intentional or accidentally on this form as well as failure to follow post-care instructions after my service.

SIGNATURE

DATE

Date

You have the right to be informed about the procedure to be used, indicating risks and benefits, so that you may make the decision whether or not to get the procedure. This authorization and consent form is an effort to make you better informed. To that end, you are encouraged to ask any questions you may have. You are also encouraged to conduct your own research or consult with your own health care provider if you have additional questions.

Waxing is a procedure to remove unwanted hair from its roots. In some areas hot, "soft" wax is applied to the skin, and a strip of cloth or paper is pressed into the preparation. The strip is then quickly pulled away, taking hairs with it. In other areas hot, "hard" wax is applied to the skin and allowed to cool. The cooled wax is then quickly pulled away, taking hairs with it.

Check the boxes below to show you agree

I agree that I am over the age of 18, am NOT under the influence of alcohol or drugs, am NOT pregnant or nursingand desire to receive the waxing procedureI have been informed of the nature, risks, and possible complications and consequences of waxing. I understand the waxing procedure may have known or unknown complications including but not limited to: allergy to wax or other products and materials used during the waxing procedure, mild discomfort when the wax removes hair from its root, skin sensitivity, skin lifting, inflammation, welts, hives, redness, and skin breakouts due to bacteria being pulled out with the hair.I understand that results may vary per client and any payments made are for the rendering of services and are notcontingent upon individual client results.I hereby authorize "Lush Skin Studio", its employees, and agents to perform the waxing procedure(s) on me. I am aware that the practice of esthetics, like medicine and surgery, is not an exact science, and I acknowledge that reputable practitioners cannot properly guarantee quality and/or results or freedom from complications. I acknowledge that I have had the opportunity to ask questions, and that I fully understand the waxing procedure.I understand and acknowledge that there are risks involved with the waxing procedure(s), including, but not limited to, those side effects listed above. I have had the opportunity to ask questions regarding these risks and other possible complications. I understand that any false or misleading information I have given may lead to undesired results and complications and hereby waive "Lush Skin Studio” of liability if such results or complications occur. I further understand that my failure to follow post-procedure instructions may also lead to undesired results, complications or effects and hereby waive"Lush Skin Studio” of liability if such results or complications occur. In consideration for "Lush Skin Studio" performing this procedure(s), I agree that I will assume the risk and full responsibility for any and all injuries, losses, or damages, which might occur to me while I am undergoing this procedure(s) or side effects I may experience after the procedure(s) is performed. To the maximum extent allowed by law, I agree to waive and release any and all present and future claims, suits or related causes of action against "Lush Skin Studio", its owners, officers, employees, or agents for negligence, injury, loss, costs or other injuries or damages to me as a result of this procedure(s).

SIGNATURE

DATE

Date

Please check boxes below to show you understand

I understand I must be 18 years or older to receive treatments. If underage, please contact us directly at lushskinaesthetics@gmail.com or text/call (360)558-8370I understand I must read all restrictions and sign/date all consent forms. Not having consent forms pre-filled will deduct time off your treatment.I understand that I may not bring a guest, children, or pets to my appointment. Any guests must wait in the lobby.I understand that if I am late to my appointment that time will be deducted from treatmentI further agree to provide "Lush Skin Studio" a minimum of 24 hour notice of a cancellation or change in appointment time, or I will have to pay a cancellation fee (50% of the service price) with the card on file. If I no-call no-show, the fee is 100% (full cost) of the original service price. If I do not pay the due amount, I understand I will not be able to book another appointment until all past dues have been paid off in full.I understand and acknowledge that payments for the above services are non-refundable.Should I decide to add a treatment, that treatment will be considered an additional and separate treatment at a separate cost.I agree to inform and notify immediately "Lush Skin Studio" should any information regarding my health history past and present change.I elect to receive this procedure from "Lush Skin Studio" knowing all of the benefits, risks, contraindications and potential complications.

Signature

DATE

Date

Lush Skin Studio

Waxing Consultation Form

PERSONAL INFORMATION

INFORMED CONSENT

POLICIES