Client Intake Form

  • Client Intake Form

    Waxing & Facials
  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Gender*
  • Would you like to be added to our email list for news & exclusive glow deals ?
  • Medical History : Do you have or have you had any of the following conditions ? If yes, please select*
  • Have you ever been treated for cancer ?
  • Any known allergies ?*
  • Are you pregnant ?*
  • Have you used any Alpha Hydroxy Acids(AHAs) or glycolic products in the past 48 hours ?*
  • Are you using Retin-A, Renova or Accutane ?*
  • Are you using any skin thinning products ?*
  • Are you exposed to the sun on the daily basis ?*
  • Do you plan to spend time in the sun soon ?*
  • Do you use a tanning bed ?*
  • Have you had a waxing treatment before ?*
  • Have you ever had a reaction to waxing ?*
  • I hereby consent to & authorize to perform the following procedure :*

  • By signing below, you agree to the following: I have complete this form truthfully and to the best of my knowledge. I agree to waive all liabilities toward my technician and the employer for any injury or damages incurred due to any misrepresentation of my health history 

  • Should be Empty: