Purr-fect Wax Studio Form

Name

First NameLast Name

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

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

Email

example@example.com

Referred by

Are you under 18?

Please fill this contraindications form to the best of your ability. Answer Yes, No or a list for your answers. Thank you!

I have not used a Retin A, a Retinol OTC, Renova, any form of Alpha Hydroxy Acid (AHA), profes or home micro dermabrasion, glycolic peel, other peels, in the last 72 hours

I have been off Acutane for at least twelve (12) months

Are you using any other skin thinning products and or drugs?

Do you use tanning beds or are you exposed to the sun on a regular basis? Do you plan to be soon?

Are you Diabetic?

Do you Smoke?

Any known allergies?

Have you ever been waxed prior to today? Did you have any reactions? If so, please explain

Are you currently taking medications? If so please list all including over the counter

Do you have any open lesions?

Do you have an active herpes outbreak, cold sore or genital?

I agree to inform my service provider if I am on my menstrual cycle (Note- you can still be waxed while on your period)

I agree to adhere to all safety post care including: no peels, tanning, no swimming or hot tubs, no 48 hours after waxing and all home skin care protocols as recommended by my service provider.

I am aware that there are often inherent risks associated with waxing and I my have unfavorable such as, but not limited to, allergic reactions, irritation, burning, redness, scarring, soreness, etc., signing below I further agree that I will not hold my provider, or establishment responsible should any above occur. I further understand that it's my responsibility to inform my provider if any of the changes.

Signature

Purr-fect Wax Studio Form

Please fill this contraindications form to the best of your ability. Answer Yes, No or a list for your answers. Thank you!

Cancellation Policy Form