Client Information / Consent-Waxing Form printable pdf download

Client Information / Consent-Waxing Form

CLIENT INFORMATION & CONSENT–WAXING

Name: ____________________________________________________________________________________________________

Address: __________________________________________________________________________________________________

City: ______________________________________________________

State: ________________

Zip: ______________

Home Phone: ____________________________________________ Cell Phone: _____________________________________

Have you used any Alpha Hydroxy Acid (AHA) or glycolic products in the past 48-72 hours?

Yes

Do you have any known allergies to any skin care products or ingredients?

Yes

Please explain:__________________

____________________________________________________________________________________________________________

What is your menstrual cycle due date? ____________________________

(Always allow ﬁve days for menstrual cycle. Because of water retention and for your own personal comfort, you should avoid hai

r removal two days before your cycle

is due and two days after it is completed.)

Please note that waxing does have certain side effects such as skin removal, redness, swelling, tenderness, etc.

I have read the above information and if I have any concerns, I will address these with my skin therapist. I give permission to my therapist to

perform the waxing procedure we have discussed and will hold her and her staff 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.

Client Name (signature) ______________________________________________Date ________________________

Client Information / Consent-Waxing Form