Waxing Waiver Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Age?
Have you used any Alpha Hydroxy Acids (AHA) or glycolic products in the past 48-72 hours?
Yes
No
Have you used Retin-A, Renova, Accutane or within the past year?
Yes
No
How recently?
-
Month
-
Day
Year
Date
Do you use any of these skincare products?
Retinol
Salicylic Acid
BHA
None
Are you using any other skin thinning products (ie. Tretinoin) and/or drugs that thin the blood?
Yes
No
Do you use tanning beds and/or are exposed to the sun on a regular basis?
Yes
No
Are you currently taking any medications? If so, please list.
Have you been treated for cancer? If yes, when and what types of therapies were used?
Please list any illness/conditions which ou are currently being treated for by a medical professional.
Do you have any open skin lesions?
Yes
No
Do you have any allergies?
Yes
No
Please list your allergies.
Do you have Herpes Simplex Virus (HSV)? (Note: Waxing can cause flare up.)
Yes
No
Please note that waxing can have certain side effects such as skin removal, redness, swelling, tenderness, etc.
I have read the above information and have given an accurate account of the questions and if I have any concerns, I will address these with my esthetician. I give permission to my esthetician to perform the waxing procedure we have discussed and will hold them harmless from any liability that may result from this treatment. I agree to adhere to all safety post care including: no peels, tanning, or wet room services; no swimming/spas/hot tubs for 72 hours after waxing; and all home skin care protocols as recommended by my service provider. I understand that my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.
No Show/Cancelation Policy
If you are unable to make your existing scheduled appointment, we kindly ask that you give us a 48 hour notice, otherwise you will be considered a "NO SHOW" and charged the full amount of the missed treatment. The best way to cancel is online through the link you are provided upon booking.
Agree
We understand delays can happen, however, we must do what we can to maintain our committed appointment times for the sake of all clients and schedules. If a client arrives more than five (5) minuets past their scheduled appointment time, it does not allow us enough time to provide the treatment. Thus the client will be considered a "no show" and charged the full amount of the missed treatment as well as a notice in the clients profile. If a client has three (3) no shows on their record we will no longer be able to book that client. Thank you for your understanding and respecting my time and business.
Agree
Photo Release Agreement
We would like your permission to use your photo for advertising and or social media. Your consent is necessary to do so. I herby give my permission A: to use, re-use, publish any photographic portraits or pictures of me. B: I relinquish any right that I may have to examine or approve the completed product or products advertising copy or printed matter that may be used in conjunction therewith or the use to which it may be applied. C: I hereby affirm that I am over the age of 18 and have the right to contract in my own name. I have read the above authorization, release and agreement, prior to this execution; I fully understand the contents thereof. This agreement shall be binding upon me and my heirs, legal representatives and assigns.
*
Agree
Disageee
Date of Waiver
*
-
Month
-
Day
Year
Date
Client Signature or Parent/Guardian Signature if client is a minor
*
Submit
Submit
Should be Empty: