Waxing Consent Form
Please fill out this form prior to your appointment.
Name
Email
Contact Number
Date of Your Appointment
When did you last shave or trim?
Have you been waxed before?
Yes
No
Do you have any tendencies towards: (Check all that apply)
Ingrown Hair
Eczema
Bruising
Bumps
Hyperpigmentation
Break Outs
Psoriasis
Scarring
Are you currently using or taking: (Check all that apply)
Isotretinoin/ Accutane
Indoor Tanning
Glycolic Acid
Alpha-hydroxy Acid
Resorcinol
Retin-A
Self Tanners
Any Scrubs or Peels
Please acknowledge the following:
I understand that if I have Herpes or Staph/MRSA, I may experience an outbreak after the waxing service. The professional explained the best way to minimize or prevent an outbreak when waxing regularly.
I understand I may carry Herpes and/or Staph/MRSA without any physical symptoms or a medical diagnosis. I also understand that the waxing service does not allow the opportunity to contract these conditions from my technician.
I understand all of the above mentioned reactions. I also understand if I change my skin care routine or medications I must inform the professional PRIOR to any service in the future.
I understand that I must be showered and prepared for my service.
I understand waxing may cause: Bruises, scabs, scarring, redness, hyper pigmentation, pimples or a flare up of any of the above mentioned Conditions/responses. Waxing of soft tissue may cause the skin to tear resulting in the need for stitches. (Most common occurrence is in Brazilian Bikini waxes, male or female.)
I understand that if I cancel or miss my appointment within the 24 hour cancellation policy I will be charged $25.00 or HALF of the service fee, whichever is greater.
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