WAXING CONSULTATION

WAXING CONSULTATION

Client Intake Form
Client information:
Name:

First NameLast Name
Birthdate:

MonthDayYear
Date
Age:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address:
example@example.com
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact:
MEDIACL HISTORY
Please mark any of the following conditions you may currently have.
Have you ever had an allergic reaction to any of the following?
Have you had waxing or any skin care treatments before and experienced a reaction?
Are you currently taking any medications or using any topical treatments? (e.g., retinoids, acne medications, etc.)
If yes please input
Have you recently had a chemical peel or microdermabrasion
(If yes, when? )
Have you had any recent surgeries or medical procedures?
If yes
Do you have any other medical conditions or concerns that you think we should know about?
If yes
Any medications (Prescribed and Over the Counter including vitamins/herbs/supplements) or Skincare products you are currently using:
If yes
(Female Clients) When is your next menstrual cycle due to begin ?
If yes
(For your personal comfort, you should avoid hair removal two days before your cycle is due and two days after it is completed.)
What services would you like to perform today?
Facial:
Legs / Arms:
Body:
Bikini:
I hereby acknowledge that I have provided accurate information regarding my medical history, allergies, and any other relevant details. I understand that waxing treatments carry some risks, including the potential for allergic reactions and skin irritation.

I release the esthetician from any liability arising from my waxing treatment, and I understand that it is my responsibility to communicate any changes in my medical history or allergies to the esthetician in the future.
Client Name:

First NameLast Name
Client Signature
Date

MonthDayYear
Date
Esthetician Name

First NameLast Name
Esthetician Signature
Date

MonthDayYear
Date
WAXING PATCH TEST

Consent and Waiver
I, First Name Last Name , acknowledge that I have requested a waxing treatment from STUDIO65 ESTHETICS (Esthetician/Salon) and understand that waxing treatments may carry some risks, including the potential for allergic reactions, skin irritation, or other adverse effects.
I further understand that a patch test is a small-scale test to assess my skin's reaction to the waxing product and is typically performed on a small area of skin before proceeding with a full waxing treatment. I acknowledge that I have been informed of the importance of a patch test and voluntarily consent to undergo a patch test as part of the waxing treatment.
I understand that the patch test will involve the application of the waxing product on a small area of my skin, and I will closely monitor the area for any adverse reactions for the duration specified by the esthetician or salon. I will report any discomfort, redness, itching, rash, swelling, or other unusual reactions to the esthetician or salon immediately.
I understand that the results of the patch test will help the esthetician or salon assess my suitability for the waxing treatment and determine any precautions or modifications that may be necessary to ensure my safety and well-being during the waxing treatment. I acknowledge that the esthetician or salon may refuse to perform the waxing treatment if I do not undergo the patch test or if any adverse reactions are observed during the patch test.
I hereby release the esthetician or salon from any liability arising from the patch test or the waxing treatment, and I assume full responsibility for any risks associated with the patch test or the waxing treatment.
Client Name

First NameLast Name
Client Signature
Date

MonthDayYear
Date
Esthetician Name

First NameLast Name
Esthetician Signature
Date

MonthDayYear
Date
CLIENT CONSENT

Client Intake Form
I, First Name Last Name , acknowledge that I have requested a waxing treatment from STUDIO65 ESTHETICS (Esthetician/Salon).
I understand that waxing treatments may carry some risks, including the potential for allergic reactions, skin irritation, redness, swelling, or other adverse effects.
I have provided accurate information about my medical history, allergies, and any other relevant details to the best of my knowledge. I understand that it is my responsibility to communicate any changes in my medical history or allergies to the esthetician in the future.
I have been informed of the expected outcomes of the waxing treatment, as well as any risks, precautions, or aftercare instructions provided by the esthetician or salon. I understand that the esthetician or salon will take reasonable precautions to ensure my safety and well-being during the waxing treatment, but there may still be some risks associated with the treatment.
I voluntarily consent to undergo the waxing treatment and agree to follow all the instructions provided by the esthetician or salon for preparation, during, and after the treatment. I understand that I may experience some discomfort, redness, swelling, or other temporary reactions after the waxing treatment, and I will inform the esthetician or salon if any unusual reactions occur.
I hereby release the esthetician or salon from any liability arising from the waxing treatment, and I assume full responsibility for any risks associated with the treatment.
Client Printed Name

First NameLast Name
Client Signature
Date

MonthDayYear
Date
Esthetician Name

First NameLast Name
Esthetician Signature
Date

MonthDayYear
Date
Client Waxing Consent

Studio65 Esthetics Waxing Information
Name:

First NameLast Name
Date of Birth:

MonthDayYear
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.
Have you used any Alpha Hydroxy Acid (AHA) or glycolic products in the past 48-72 hours?
Are you using Retin-A, Renova or Accutane (an oral form of Retin-A)?
Are you using any other skin thinning products and/or drugs?
Are you exposed to the sun on a daily basis or are you considering spending more time in the sun soon?
Do you use a tanning bed?
Are you diabetic?
Are you currently taking medications? If so, please list all (including over the counter drugs/herbal supplements):
What skin products do you regularly use on your skin?
Have you ever been treated for cancer? If yes, when and what types of therapy were used?
Please list any other illnesses or conditions you are currently being treated for by a medical professional:
When is your next menstrual cycle due to begin?

MonthDayYear
Date
Studio65 Esthetics Waxing Consent Form
Please be aware that waxing may have certain side effects, including but not limited to redness, swelling, tenderness, skin irritation, or minor skin removal. I acknowledge that I have read this information, and if I have any concerns, I will address them with my esthetician prior to the treatment.

By signing this form, I give permission to my esthetician at Studio65 Esthetics to perform the waxing procedure we have discussed. I agree to hold the esthetician and Studio65 Esthetics harmless from any liability resulting from this treatment.

I confirm that I have provided accurate information regarding any allergies, medications, or products I am currently using, both orally and topically. I understand that my esthetician will take all necessary precautions to minimize or prevent adverse reactions to the best of their ability.

I have read and understand the post-treatment care instructions provided. I am committed to following the recommended home care routine to minimize any potential side effects. If I have additional questions or concerns about the treatment or recommended post-treatment care, I will consult my esthetician immediately.

I agree that this form constitutes full disclosure and supersedes any prior verbal or written disclosures. I confirm that I have had the opportunity to discuss any questions I may have about the procedure and that I fully understand the risks involved.

I do not hold my esthetician or Studio65 Esthetics responsible for any conditions not disclosed prior to the treatment that may be affected by the procedure performed today.
Client Name

First NameLast Name
Client Signature
Date

MonthDayYear
Date
Esthetician Name

First NameLast Name
Esthetician Signature
Date

MonthDayYear
Date
Should be Empty:

WAXING CONSULTATION

MEDIACL HISTORY

WAXING PATCH TEST

CLIENT CONSENT

Client Waxing Consent

Studio65 Esthetics Waxing Consent Form