Waxing Consent Form

Customer Name

First NameLast Name

Customer Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Customer Email

example@example.com

Age

Gender

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?

Are you currently using any cosmetic products that may contain the following substance? Kindly check if yes and if no, leave it blank.

I am providing my consent to complete the procedure I am requesting for I am duly aware of the side effects of waxing to my skin during or after the procedure such as:
skin redness, swelling, skin irritation, bruises, skin lifting or bumps.

I acknowledge that all skincare treatments provided may involve potential side effects depending on my individual skin type and sensitivity. I understand that reactions such as redness, irritation, breakouts, dryness, or other unforeseen responses may occur as a result of the treatment.

I hereby affirm that I have read and fully understand the information provided above. I confirm that I am over eighteen (18) years of age, or that my legal guardian is present and has provided consent on my behalf. I accept full legal responsibility for my decisions and actions.

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

Customer Signature

Date Signed

Date

Waxing Consent Form

Waiver Consent