WAX CONSULTATION & CONSENT FORM
Please complete this form to help us provide a safe and personalized head spa and mini facial experience. Your information will remain confidential.
Client Information
Please provide your personal and contact details.
Full Name
*
First Name
Last Name
Email
*
Phone Number
*
Format: (000) 000-0000.
Date
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Month
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Day
Year
HEALTH & SAFETY SCREENING
Please answer the following:
Do you have sensitive skin or any known allergies?
*
No
Yes
Details
*
Are you currently using Retinol, Accutane, acne medication, or strong exfoliating products?
*
No
Yes
Details
*
Have you had any recent peel, laser, microneedling, waxing, or sun exposure in the treatment area within the past 2 weeks?
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No
Yes
Details
*
Do you currently have any rash, irritation, open skin, cuts, cold sore, infection, or sunburn in the treatment area?
*
No
Yes
Details
*
Are you pregnant, breastfeeding, or taking any medication that may affect your skin or healing?
*
No
Yes
Details
*
CLIENT CONSENT
*
I confirm that the information above is accurate to the best of my knowledge. I understand that waxing may cause temporary redness, sensitivity, or irritation. I agree to inform the provider of any allergy, medication, skin condition, or discomfort before service. I understand that service may be modified, postponed, or declined if it is not safe to proceed.
Client Signature
*
Date Signed (Client)
*
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Month
-
Day
Year
Date
Submit Consultation & Consent
Submit Consultation & Consent
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