New Wax Client Questionnaire
This form must be filled out at least 12 hours before your appointment, or your appointment may be rescheduled. If you have any questions, please call or text 586-231-5077!
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Have you taken Accutane in the last 12 months?
Yes
No
Please list any allergies.
Are you using Retin-A, Retinol, Tretinoin, Differin, Renova (or similiar)?
Yes
No
Have you used any sort of chemical exfoliant in the last 7 days? (AHA, BHA, Glycolic Acid, Salicylic Acid, etc)?
Yes
No
Have you received a chemical peel in the last 12 months?
Yes
No
Please list any medical conditions and/or any medications you are currently taking.
Please list any questions or things you want me to know.
Are you under the age of 18? If the answer is YES, a parent or guardian is required at your first service.
Yes
No
I acknowledge that I was truthful with all of my answers. I acknowledge that if I do not disclose certain medical conditions, medications, skin history, skincare products, etc, my cosmetologist is not responsible for skin tearing or irritation.
Yes
I agree to the following cancellation and late policy: Any cancellations made within 12 hours of your appointment will result in a 50% fee of your service to compensate for the lost appointment time. If you are running late, please send me a message or call the salon. If you are 10 or more minutes late, depending on my schedule that day, your appointment may need to be rescheduled or a service may have to be taken off. Thank you!
Yes
If you are getting a bikini wax, would you like to add on an intensive hydrating hydrojelly mask ($20)
Yes
No
N/A
Signature
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Should be Empty: