Waxing Consent/Home Care Form
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Have you used any Alpha Hydroxy Acid (AHA) or glycolic products in the past 48-72 hours?
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Yes
No
Are you using Retin-a, Renova or Accutane (an oral form of Retin-a)?
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Yes
No
Are you using any other skin thinning products and/or drugs?
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Yes
No
Are you exposed to the sun on a daily basis or are you considering spending more time in the sun soon?
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Yes
No
Do you use a tanning bed?
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Yes
No
Are you diabetic?
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Yes
No
Are you currently taking medications? If so, please list all (including over the counter drugs/herbal supplements):
*
What skin products do you regularly use on your skin?
*
Have you ever been treated for cancer? If yes, when and what types of therapies were used?
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Please list any other illness/condition you are currently being treated for by a medical professional
*
Photo Release
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I give permission for my hair to be photographed and used for marketing/social media
I do NOT give permission
Female clients
When is your next menstrual cycle due to begin?
Always allow five days for menstrual cycle. Because of water retention and for your own personal comfort, you should avoid hair removal two days before your cycle is due and two days after it is completed.
Please note that waxing does have certain side effects such as skin removal, redness, swelling, tenderness, etc.
I have read the above information and if I have any concerns, I will address these with my skin therapist. I give permission to my therapist to perform the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment.I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.I have read and understand the post-treatment home care instructions. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product / post-treatment care, I will consult the esthetician immediately.I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the esthetician responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.
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Date Signed
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To ensure maximum comfort and benefit after the treatment, it is important to follow the steps below at home: • Avoid applying heat to the waxed area for 12 to 24 hours. This includes hot baths, sauna, and steam. • Use an anti-acne lotion for face, back and chest following the treatment and twice a day until breakouts are gone. Use only an anti-acne product recommended by your skin care professional. • Avoid suntanning for 12 to 24 hours. This includes any strong ultraviolet (UV) light exposure or tanning bed treatments. • Avoid applying highly fragranced products to the waxed area. This includes, perfume, scented body lotions, anti-perspirants, cosmetics, or feminine hygiene sprays. Only use professional products, recommended to you by the skin care therapist who performed the waxing service • Avoid using harsh abrasive or exfoliates in the waxed area. However if you are prone to in-grown hairs, the day after your waxing treatment, exfoliate newly waxed area with an Exfoliating glove to avoid future problems. • Avoid applying high SPF sunblocks to the waxed area for 12-24 hours after the waxing service. Sunscreen chemicals can be irritating to the newly waxed skin. This includes self-tanning products and tan accelerators. • Any pinking of the skin should disappear within 6 to 8 hours after the waxing treatment. Slight pinking is normal, and indicates that the hair was removed from the root, rather than superficially broken off, as in shaving. This is the reason that professional waxing lasts so much longer. For best results, repeat your professional waxing every 4 to 6 weeks depending on the area and your individual hair growth rate. If you have any questions about your waxing service or after care at home, please do not hesitate to call your skin care therapist.
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Date Signed
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