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!
Important
Please fill out this form only AFTER booking your appointment. https://booking.mangomint.com/260520
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How did you hear about me?
Do you have any of the following in the treatment area: sunburn, open cuts or sores, psoriasis, eczema, dermatitis, recent surgery?
*
Yes
No
Have you taken Accutane in the last 12 months?
*
Yes
No
Date of last Accutane dose (MM/DD/YYYY) or N/A
*
Please list any allergies.
*
Skin type
*
Normal
Dry
Combination
Acne prone
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. Example: “I would like to reduce my ingrown hairs” or “This is my first wax, can I bring a friend?”
*
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 certify that the information I have provided is complete and accurate. I understand that withholding information regarding medical conditions, medications, skin history, or skincare products may result in adverse reactions, including skin lifting, tearing, or irritation. I acknowledge that my cosmetologist is not responsible for any complications arising from undisclosed information.
*
Yes
I acknowledge that my hair must have approximately 4 weeks of growth prior to my waxing appointment for optimal results. I understand that if my hair is too short at the time of my appointment, the service may need to be rescheduled to prevent irritation, ingrown hairs, and unsatisfactory results. I further understand that arriving without sufficient hair growth will result in a 50% service charge.
*
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 5 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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