HAIR REMOVAL CONSENT & LIABILITY FORM

HAIR REMOVAL CONSENT & LIABILITY FORM
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
friend/referralinstagramtiktokother
BY SIGNING THIS CONSENT & LIABILITY FORM, YOU DECLARE THAT THE ANSWERS GIVEN HEREIN ARE TRUE AND COMPLETE TO THE BEST OF YOUR KNOWLEDGE

FALSE OR MISLEADING ANSWERS CAN LEAD TO COMPLICATIONS AND/OR UNDESIREABLE RESULTS
have you taken accutane within the past few months?
if so, provide date of last dose
are you pregnant, diabetic, or receiving cancer treatments?
are you using any antibiotics, birth control, or hormone replacements? if so, please specify
do you have aids, lupus, or any chronic condition(s) that may compromise the skin barrier?
if so, please specify
do you have any allergies to wax or latex?
yes/no
have you used a tanning bed or experienced prolonged sun exposure within the past 24 hours?
yes/no
do you have rosacea, eczema, psoriasis, cracked or open skin, severe varicose veins, or any skin sensitivity?
if so, please specify
are you currently menstruating or about to begin menstruating?
yes/no
IF ANY OF THESE CONTRAINDICATIONS APPLY TO YOU,

PLEASE REFRAIN FROM BOOKING WAX SERVICES,

IT WILL BE PAINFUL/HARMFUL TO YOUR SKIN BARRIER
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