Body Waxing Consent and Intake Form

Body Waxing Consent and Intake Form - JasWax

Please complete this form to provide your information, health history, and consent for body waxing services.
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Have you ever had waxing services before?
Have you tanned in the last 24 hrs?
Which areas do you wish to have waxed today?

Other
Do you have any allergies (especially to adhesives, wax, or skincare products)?
If yes, please specify your allergies:
Do you have any of the following conditions? (Select all that apply)

Other
Are you currently on any acne or photosensitive medications?
Are you currently taking any medications? If yes, please list them.
Did someone refer you?
Do you have any concerns for today?
Is there anything else we should know about your health or skin?
I acknowledge that waxing carries inherent risks including, but not limited to, skin irritation, redness, swelling, allergic reactions, and potential injury. I understand these risks and release JasWax and its representatives from any liability arising from the waxing procedure.
Consent Agreement (Initial)
Signature
Minor Consent Section
Parent or Guardian Name
Parent or Guardian Signature
Should be Empty:

Body Waxing Consent and Intake Form - JasWax