Hair removal / Waxing Form🌸

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Birthday

Date

Age

Date of appointment

Date

Gender

Have you been waxed before?

Currently using/ or have done: (please check all that apply as the following are potential contraindications for waxing!)

Any skin treatments you may have had and the dates you received them

Any medical conditions or medications you have taken, if any.

Pregnant or lactating ?

Seen or seeing a dermatologist?

Name of Doctor

Allergies to products or medications, if any.

History of fever blisters or cold sores?

Tanning regime or use of tanning booths? If so, how frequently?

I understand that topical creams, medical conditions, and medications can affect the results of waxing. I understand that I cannot be waxed if I have certain contraindications such as taking topical acne drugs or if l am using Retin-A® (or other peeling agents) topical prescription products.

I understand that I am accepting full responsibility for skin reactions if I do not inform my technician of contraindications prior to waxing

Certain medications, products, and treatments used prior to waxing may result in irritation, skin peeling, blotchiness, pigmentation, and sensitivity.

I understand that some redness and/or sensitivity may result. I agree to avoid sun exposure, excessive heat (saunas, hot tubs), and all active products for the next 48 hours or as instructed by the technician.

The hair removal process has been explained and I have had an opportunity to ask questions and receive satisfactory answers.

I consent to be waxed and will not hold Jasmine Marenco responsible for any adverse reactions from treatments or products.

The hair removal process has been explained to me, and I had the opportunity to ask questions and receive satisfactory answers.

Client’s name & signature printed

First NameLast Name

Are you ok with being posted for content?

Client’s Signature

Parent or guardian if under the age of 18!

First NameLast Name

Signature

Esthetician: Jasmine Marenco