Waxing Consent, Liability Release & Media Agreement Form

Waxing Consent, Liability Release & Media Agreement Form
Welcome to Divinely Yu Esthetics. We’re honored to be a part of your self-care journey. To ensure your safety and satisfaction, please take a moment to review and complete this form before your waxing service begins.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Currently using Accutane, Isotretinoin, or similar acne medication (must discontinue for at least 6 months before waxing)Currently using Retin-A, Tretinoin, Differin, or any other topical retinoids (must discontinue for at least 7 days before waxing)Have sunburn, open wounds, rashes, or skin conditions (e.g., eczema, psoriasis) in the area to be waxedTaking antibiotics or steroids (can cause skin sensitivity)Taking blood thinners (e.g., Warfarin, Aspirin)Using prescription-strength skincare (e.g., hydroquinone, AHAs, BHAs, benzoyl peroxide)Have had chemical peels, microdermabrasion, or laser treatments in the past 2 weeksHave diabetes or other conditions that affect healing
Are you Pregnant?*
Please list any allergies.*
If under the care of a dermatologist please list prescribed medications.*
I understand that waxing may cause redness, irritation, bumps, ingrown hairs, or skin lifting.I acknowledge that I have disclosed any medications or conditions that may affect my waxing experience.I understand that I should avoid sun exposure, swimming, tanning beds, saunas, and exfoliation for at least 24-48 hours after waxing.I understand that results may vary based on my skin type, hair growth, and adherence to aftercare instructions.
Liability Waiver & Release
I acknowledge that I have voluntarily chosen to receive waxing services from Divinely Yu Esthetics. I understand that waxing involves the removal of hair from the root, which may cause skin reactions. I release Divinely Yu Esthetics and its estheticians from any liability for skin reactions, burns, irritation, infections, or injuries that may occur due to waxing.

I confirm that I have disclosed all necessary medical information and understand that failure to do so may increase the risk of adverse reactions. I accept full responsibility for any consequences resulting from my waxing treatment.

I understand that Divinely Yu Esthetics is not liable for any pre-existing conditions, improper aftercare, or reactions due to undisclosed medications or skin conditions.
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Media Consent (Optional)
Yes – I grant Divinely Yu Esthetics permission to use images/videos of my waxing service for educational content, social media, marketing, or training purposes. My identity may be concealed upon request.No – I do not consent to any recordings or media use.
Date*

MonthDayYear
Date
Signature*
Should be Empty:

Waxing Consent, Liability Release & Media Agreement Form

Welcome to Divinely Yu Esthetics. We’re honored to be a part of your self-care journey. To ensure your safety and satisfaction, please take a moment to review and complete this form before your waxing service begins.

Media Consent (Optional)