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?