New Client Brazilian Wax Form

New Client Brazilian Wax Form

Professional Skin Waxing Salon
By submitting this online form you will save time during your first appointment. Your form will be printed out and waiting for you at the salon. Simply tell us you completed this form. Thank you
Full Name *

First Name Last Name
Age Group *

Younger the 18 18 - 25 26 - 30 31 - 49 Over 49
I am sorry but we DO NOT perform Brazilian Waxing on customers under the age of 18. Thank you.

New Client - {fullName}
How did you here about us?

Referral Google Search Other Internet Search Driving by Facebook Instagram Other Social Media

New Client - {fullName}
PRIVACY NOTICE:
Your address below is for our internal records ONLY! We WILL NOT mail you any information.
Address *

Street Address

Street Address Line 2

City State

Zip Code

New Client - {fullName}
We need to know just a few things so we can provide you with a safe and efficient wax.
Is this your first Brazilian Wax? *

Yes No
AWESOME! You are going to love it!
Have you ever had a reaction to a waxing service? *

Yes No Not Sure
No problem. You can explain the reaction you had when you come to your appointment.
Will you be tanning prior to your wax appointment? *

Yes No
NOTE!
You may still get waxed but DO NOT tan within 3 days of your wax appointment

New Client - {fullName}
Are you taking any of the following medications?

Retin A or Retinal products Alpha Hydroxy Acid Accutane
WARNING!
The medication you selected can cause an adverse reaction to waxing. Once you are off your medication for 3 Months you can get waxed. Your safety is important to us.
Is there anything else you would like us to know prior to your wax?
Should be Empty: