Waxing Consent Form

Please answer the health and skin checker for the safety of the procedure:

Rows	Yes	No	Remarks
Have you done any waxing before?
Are you currently taking any medications?
Have you had any skin thinning treatments before?
Are you Pregnant? (Female)
Do you have sensitive skin?
Do you have skin allergies?
Do you bruise easily?
Are you prone to scarring and hyperpigmentation?
Do you have or suffer from cold sores/HSV-1/HSV-2/Fever Blisters
Warts, staph infections, or MRSA
Fungal infections (ringworm, athlete’s foot)
Scabies or lice
Recent flu, COVID-19, or contagious illness (within 14 days)
Open wounds, cuts, or abrasions on the waxing area
Acne, eczema, psoriasis, or rosacea
Sunburn or excessive skin sensitivity
Blood disorders or use of blood thinners
Chemotherapy or radiation treatments
Diabetes (affects healing and sensitivity)
Autoimmune disorders
Other

Accutane Retin-A or retinoidsRenovaDifferinAHABHAGlycolic AcidSteroid creams or prescription skin treatmentsAntibiotics that cause sun sensitivityBotox or fillers (last 2 weeks)Recent chemical peels, microdermabrasion, or laser treatments
For the health and safety of all clients and staff, please initial to confirm you do not currently have any contagious skin conditions or illnesses.*
Waiver Consent
I understand that waxing can cause temporary redness, irritation, bruising, bumps, or sensitivity. I acknowledge that certain conditions and medications can increase skin sensitivity, leading to possible side effects.

I am responsible for disclosing any skin conditions, medications, or recent treatments that may affect my waxing service.

The esthetician reserves the right to refuse service if it is deemed unsafe for my skin condition.

I release Coquette Beauty LLC from any liability related to skin reactions, infections, or adverse effects resulting from my service.

By signing below, it means that I agreed to the terms indicated in this document.
I Agree
Customer Signature*

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Waiver Consent