Client Consent Form

FirsNameLast Name
Date

MonthDayYear
Client Consent Form

Snatched Beauty, LLC
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Birthday (Date/Month/Year)
May we contact you via SMS (text) message and email for appointment confirmations confirmations and Snatched Beauty, LLC marketing promotions?

YesNo
Email
example@example.com
How did you hear about us?
Referred By:
Do you have any tendencies towards the following? Please select all that apply

Ingrown HairsHyperpgmentationBreakoutsBumpsBruisingEczemaPsoriasisScarring
Are you currently under any of the following treatments? If yes please specify:
Please select all medications that applies

Isotretinoin/AccutaneRenovaAny Scrubs/PeelsDerma/PeelinResorcinolProducts with Glycolic AcidCorticosteriodsLymph Node RemovalIndoor TanningSelf TannersPrednisoneRetin-AReinolAlpha-Hydroxy AcidKenalogElocon
Herpes

YesNo
Staph/MRSA

YesNo
Do you have any skin allergies including beeswax based products?

YesNo
Do you have any allergies? If so please be specific:
What body part(s) are we waxing today? Are any of the parts sensitive?
Have you waxed the specific areas above before?

YesNo
What previous locations have you received waxing treatments? Have there been previous issues while waxing?
Please check any of the below that may apply to you:

Open woundsAsthmaEpilepsyPsoriasisConjunctivitisPregnancyVerrucaCold SoresSunburnImpetigoRashesRecent ScarsRingwormBurns
Are you on any medication taken orally or applied topically? If yes, please provide details.
Have you had a recent Skin peel, Microdermabrasion or are you using Glycolic based skincare? Or have you had any recent filler injections?
I confirm that the above information is true to the best of my knowledge and belief. I have been fully informed about the expected results and effects of treatment and agree to follow all the aftercare advice provided by my therapist. I hereby give my consent to proceed with treatment.

Under GDPR rule, I understand that I have full access to all data held on me. This data will be held by the clinic for no longer than six years for insurance purposes, after which, digital information will be deleted permanently, and paper documents will be destroyed. All information on myself is kept on password encrypted hard drives or locked in filing cabinets to which only selective staff members have access. None of my personal data will be sold or used for anything other than to provide the services of this salon.
Signature*

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Client Consent Form

Snatched Beauty Photo Consent