WAX CONSENT FORM
Client Consent and Release Form
Name
*
First Name
Last Name
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Age?
*
Have you used Retinol or Retin-A, in the last two weeks? If so, we cannot wax the area.
*
Yes
No
Are you on Accutane medication? If so we cannot wax.
Yes
No
Do you use tanning beds and/or are exposed to the sun on a regular basis? If you are sunburn, we cannot wax
*
Yes
No
Have you used any Alpha Hydroxy Acids (AHA) or glycolic products in the past 48-72 hours?
*
Yes
No
Are you currently taking any medications? If so, please list.
Please list any illness/conditions which you are currently being treated for by a medical professional.
Do you have any allergies? If so, please list.
Please note that waxing can have certain side effects such as skin removal, redness, swelling, tenderness, etc.
I have read the above information and have given an accurate account of the questions and if I have any concerns, I will address these concerns with The Artistry LLC technician/esthetician
I give permission to The Artistry LLC esthetician/technician to perform the waxing procedure we have discussed and will hold The Artistry LLC and esthetician/technician harmless from any liability that may result from this treatment.
I agree to adhere to all safety post care including: no peels, tanning, or wet room, sauna services; no swimming/spas/hot tubs for 72 hours after waxing.
I understand that The Artistry LLC and its technicians/estheticians will take every precaution to minimize or eliminate negative reactions as much as possible.
Signature of Client
Print Name
First Name
Last Name
Date:
Submit
Should be Empty: