Waxing Consent Form

Waxing Consent Form

Waxing Consent Form
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Age

Please answer the health and skin checker for the safety of the procedure:

Rows	Yes	No	Remarks
Have you done any waxing before?
Are you currently taking any medications?
Have you had any skin thinning treatments before?
Are you Pregnant? (Female)
Do you have sensitive skin?
Do you have skin allergies?
Do you bruise easily?
Are you prone to scarring and hyperpigmentation?

Accutane Retin-A or retinoidsRenovaDifferinAHABHAGlycolic Acid
Waiver Consent
I am providing my consent to complete the procedure I am requesting for I am duly aware of the side effects of waxing that may happen to my skin during or after the procedure such as:
skin redness, swelling, skin irritation, bruises, or bumps.

I acknowledge and completed health and skin checker, efficiency, and accuracy.

I hereby affirm that I have read and fully understand the above, am over eighteen years of age and am legally liable for my own decisions/actions.

By signing below, it means that I agreed to the terms indicated in this document.
Customer Signature
Date Signed

MonthDayYear
Date
Should be Empty: