Waxpro Waxbar Consent to Vajazzle

Vajazzle

Please answer the following questions, ALL information given today is fully confidential and is ONLY used so that your WAXPRO can provide the safest and most comfortable treatment possible.

Name*

First NameLast Name

Date*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Birth Date*

MonthDayYear

Phone Number*

This is my:*

We want our clients to feel at ease. Let's Jam to your favorite tunes during your appointment!

Cellphone Carrier/Provider*

E-mail*

Best way to remind you of your appt?

How did you hear about us?

We want our clients to feel at ease. Lets jam to your favorite tunes during your appointment!

What is your favorite artist/station on Pandora?

History:

	YES	NO
Do you have any skin conditions ie: Eczema, Sensitivity, or any allergic conditions?
Have you ever had an allergic reaction to any glues or adhesives?
Have you ever been vajazzled before?

Please list:

What over-the-counter or prescription skin care products are you currently using?

Please list any medications you are taking; including over-the-counter herbs, vitamins, and supplements:

If you have had an adverse reaction from vajazzling, please explain:

Skin Preparation:

Ensure that the area is clean. We recommend no hair at all! (if there is no hair the vajazzle can be placed in the middle where it is the safest to be and can last longer too.)

Your Waxpro will prep the area with alcohol and dry off, then will apply the crystals to the skin.

The crystals should last 2-5 days.

Wear loose clothing around the area where crystals are applied. Wearing tight fitting clothes will rub the stones off.

Avoid applying any oils, lotions, or creams around the area, as vajazzles may come off inadvertently.

Also avoid really hot showers, spas as the glue will melt and this means crystals may fall off.

To remove the crystals gently peel off in the shower.

Although every precaution will be made to ensure your safety and well-being before, during, and after your vajazzle application please be aware of the possible risks below. Please read carefully.

Client Agreement:

I understand that vajazzling can be a problem for those with sensitive skin: eczema, or allergic conditions.

I understand that vajazzling can increase risks of infectiion if not properly cleansed.

I have read the above information and if I have any concerns, I will address these with my Waxpro. I give permission to my Waxpro to perform the vajazzling procedure we have discussed and waive all liabilities toward WAXPRO WAXBAR and staff from any injury or damages that may result from this treatment. I agree that this constitutes full disclosure, 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 Waxpro, whose signature appears below, 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.

By my electronic signature below, I agree to the Waxpro Waxbar client agreement above.

Client Signature*

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Waxpro Signature

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