waxing consent form

Client Information and Consent - Waxing

Please complete our online Waxing Consent Form below or fill out the Waxing Consent Form PDF.

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Email
Have you used any Alpha Hydroxy Acid or glycolic products in the past 48-72 hours?*
- Yes
- No
Are you using Retin-a, Renova, or Accutane (a form of Retin-a)?*
- Yes
- No
Are you using skin thinning products and/or drugs?*
- Yes
- No
Are you exposed to sun on a daily basis or are you considering more time in the sun soon?*
- Yes
- No
Do you use a tanning bed?*
- Yes
- No
Are you a diabetic?*
- Yes
- No
Are you currently taking medications? If so, please list all (including over-the-counter drugs and herbal supplements)*
What skin products do you regularly use on your skin?*
Have you ever been treated for cancer? If yes, when and what types of therapies were used?*
Please list any other illness/condition you are currently being treated for by a medical professional. Please list any other illness/condition you are currently being treated for by a medical professional.*
(Female clients) When is your next menstrual cycle due to begin?
MM slash DD slash YYYY

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