Waxing Consent Form

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

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

How often do you have waxing done?

Have you ever had a reaction to a waxing service?

If yes, please describe

If NO, please indicate NA

Do you have any tendencies to (check all that apply):

Are you allergic to anything?

if yes, please descibe:

If NO, please indicate NA

Have you received Botox treatments within the last 72 hours?

Have you been or will you be in the sun and/or tanning bed within 24 hours of this treatment?

Are you using or taking (check all that apply):

Are there any other medications you are taking?

if NONE, please indicate NONE

Are you currently pregnant?

Do you have Diabetes, Phlebitis or any skin irritations?

Is your skin dry?

I have been advised the service(s) provided to me by this salon could have unfavorable results including, but not limited to: allergic reaction, irritation, burning, redness, soreness, etc.. I am aware that certain medications and over the counter products can significantly increase the risk of injury when combined with skin care services. I understand that Paparazzi Spa does not recommend skin care services for customers using Retin-A, Accutane and products contacting alpha hydroxyl, or any other skin thinning treatments. I hereby confirm that I am not using any medicaitons that may cause or contribute to such injury/reaction, and I will advise my esthetician should I use any such medications in the future. I undestand there are often inherent risks associated with skin care services, and I agree that as a condition of providing these services on an on going basis, I will not hold Paparazzi Spa and/or the esthestician liable.

Signature

Date