Waxing Intake & Consent Form

Name

First NameLast Name

Phone Number

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

Email

example@example.com

Are you under the age of 18? (Please note if you’re under 18 must get approval by legal guardian)

Are you currently taking Accutane or have been on Accutane in the last 12 months?

Have you used any products containing retinol or alpha hydroxy acids in the last 7 days?

Are you using any medications or skin thinning products? If so please specify!

Do you have any allergies?

If you’ve tanned or sunbathed, when was the last time you were exposed?

Are you diabetic?

Have you ever had a wax before?

Proper hair removal requires hair to be 1/4 inch in length (the size of or longer than a grain of rice). If hair is not the required length, hairs may be left behind. Typically 2-4 weeks of growth is required for face or body waxing. Is the hair you intend removing the proper length?

Do you agree to adhere to all safety precautions/post care including: no chemical peels, exercise, tanning, swimming, hot tubs, or intimacy for 24-48 hours after waxing?

It is your choice to recieve waxing services. You understand and voluntarily accept the risks associated with all waxing services. This includes: allergic reaction, skin irritation, burns, scarring, bruising, and/or soreness. You agree that this waiver is in effect for all waxing services. By signing this form, you agree to the above terms, authorizing Escape With Mimi to retain your personal information on your private client account.

You agree to notify Escape With Mimi of any changes in relationship to this form.

Escape With Mimi will not treat clients with: questionable medical conditions, open wounds or sores, infections, healing incisions, et cetera.

You understand that the treatments you receive are not a substitution for medical treatment.

I understand that it is imperative that I disclose all of the information requested in the Client Profile/Health History.
I have cited all conditions and circumstances regarding my health history, medications being taken, and any past reactions to products or medications.
I understand that additional conditions could occur or be discovered during the procedure which could affect my ability to tolerate the procedure.

Acknowledgement and Waiver

I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement.

By signing below, I verify that I have read and understand the above statements and agree to them.

Signature

Waxing Intake and Consent Form