WAX CONSULTATION FORM

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What body part are we waxing today?textrequireddb save
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When did you last shave or trim?textoptionalno save

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Have tou been waxed before?
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Do you have any tendencies towards:

Ingrown hair
Break outs
Bumps
Hyperpigmentation
Bruising
Scarring
Eczema
Psoriasis

Are you currently using or taking:

Isotretinoin/Accutane
Retin-A
Alpha-hydroxy Acid
Resorcinol
Glycolic Acid
Any Scrubs or Peels
Indoor Tanning
Self Tanners

Madical Data

Herpes Virus
Staph/MRSA
Allergies
If Allergies, please listtextoptionalno save

Other informationtextoptionalno save

Initialsrequired

Waxing may cause: Bruises, scabs, scarring, redness, hyperpigmentation, 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.)


Initialsrequired

I understand that if I have Herpes or Staph/MRSA, I may experience an outbreak after the waxing service. The professional has explained the best way to minimize or prevent an outbreak when waxing regularly.


Initialsrequired

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.


Initialsrequired

I understand all of the above mentioned reactions. I also understand if I change my skin care routine or medications I must in-form the professional PRIOR to any service in the future.


Initialsrequired

I understand that I must be showered and prepared for my service.


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.


Date: 14.05.2020

Time: 6:10 PM

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Technician Nametextoptionalno save

Date: 14.05.2020

Time: 6:10 PM

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