client waxing intake +liability form Name * First Name Last Name Phone * (###) ### #### What waxing service(s)? are you receiving? Brow Face Brazilian/Bikini Body wax (arm, leg, underarm...) Is this your first time receiving this specific waxing service? * Yes No Has it been more than 3 weeks since your last wax for this area? * Yes No Are you on any medication that could thin the skin? * If so, we recommend doing a patch test before your appointment to avoid having your skin rip during the service. Yes No I'm not sure Are you using any prescribed topical at home treatments? (retinol, tretinoin) (Face/Brow waxing only) * If so, please stop using for 1 week prior to appointment. Yes No Do you frequently use sun beds? * Yes No Sometimes Have you had any recent dermatology procedures (botox, filler, laser, microdermabrasion…)? * Yes No If yes, what procedure and how long ago did you receive it? I have read the above information and if I have any concerns, I will address these with my esthetician. I give permission to my esthetician to perform the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment. I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand that my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. Waxing does have certain side effects such as redness, bruising, tenderness, etc.; although this is rare. In the event that I may have additional questions or concerns regarding my treatment or aftercare, I will consult my esthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read and fully understand that above paragraph. I understand the procedure and accept the risks. I do not hold my aesthetician responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today. Signature * First Name Last Name Thank you!
