Client Intake Form

Any known allergies ?*

YesNo

If yes, list them :

List any medication you take regularly( include vitamins, herbal supplements)

When is your next menstrual cycle due to begin ?*

Type “N/A” if not applicable

Are you pregnant ?*

YesNo

Have you used any Alpha Hydroxy Acids(AHAs) or glycolic products in the past 48 hours ?*

YesNo

Are you using Retin-A, Renova or Accutane ?*

YesNo

Are you using any skin thinning products ?*

YesNo

Are you exposed to the sun on the daily basis ?*

YesNo

Do you plan to spend time in the sun soon ?*

YesNo

Do you use a tanning bed ?*

YesNo

Have you had a waxing treatment before ?*

YesNo

Have you ever had a reaction to waxing ?*

YesNo

What other skin products do you use regularly on your skin ?

I hereby consent to & authorize to perform the following procedure :*

I agree to adhere to all safety post care including: no peels, tanning, or wet room service; no swimming/spas/hot tubs for 72 hoursI do not have any open skin lesions or active herpes outbreak(cold sore or genital)For Brazilians & Bikini Waxing: I will notify my Esthetician if I’m on my menstrual cycle.I understand that my Esthetician have the right to refuse services for all waxing if proper hygiene is not followed.I am over 18 years of age or I have parental consent co-signed below.Certain medications & OTC products can increase risk of injury when combined with waxing. I am not using any medications that may cause injury or reaction. I will notify my esthetician know if anything changes.

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

Client Name *

(Printed)

Client Signature *

Parental Consent

If you’re under 18

Parent Signature