Waxing Consent / Client Intake Form (Page 2 of 2) in pdf

Waxing Consent / Client Intake Form Page 2

all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my

esthetician will take every precaution to minimize or eliminate negative reactions.

I have read and understand the post-treatment home care instructions. I am willing to follow the recommendations

made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the

event that I may have additional questions or concerns regarding my treatment or suggested home product/post-

treatment care, 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 the above paragraphs and that I have had sufficient opportunity for discussion to

have any questions answered. I understand the procedure and accept the risks. I do not hold the esthetician, whose

signature appears below, 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.

_________________________________________________ _____________________________

Client Signature

Date

_________________________________________________

_____________________________

Therapist Signature

Date

Waxing Consent / Client Intake Form Page 2