Wax Consent Form

Consent for Body Waxing

Please read and fill out this consent form before your waxing appointment.
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please answer health checker + skin checker for safety of procedure

Rows	Yes	No	Remarks
Do you have skin allergies?
Are you currently on any medication?
Have you had any skin thinning treatments?
Are you pregnant?
Do you bruise easily?
Have had waxing done in the past?

Are you currently on any cosmetic products or medication that contain the following?
Do you have any allergies or skin conditions we should be aware of?
I am providing consent for service provider to complete body waxing service I have requested. I am aware that by getting this service side effects such as

skin redness, swelling, irritation, bruises, skin lifting, or bumps can happen.

I have completed and answered health and skin checker to the best of my knowledge.

I understand that cosmetic products or chemical substances itemized are hazardous when coupled with waxing and can cause skin lifting of the skin and poor results.

I hereby affirm that I have read and understand the information provided, am 18 years of age and legally liable for own decisions/actions-
Signature
Should be Empty:

Consent for Body Waxing