Brazilian Wax Intake Form
Provide your medical details and agree to policies before your appointment.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you currently taking any medications (including topical creams)? If yes, please list them.
Have you ever had sensitivity or reaction to waxing?
Yes
No
Do you have any of the following skin conditions? (Check all that apply)
Eczema
Psoriasis
Active acne
Open wounds or sores
None of the above
Other
When was the last time you shaved the area to be waxed?
*
Last Waxing Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you currently on your period?
Yes
No
Prefer not to say
You’re welcome to get waxed while on your period. If you’re not comfortable, that’s completely okay — all policies still apply to your appointment at the studio.
Submit Intake
Should be Empty: