Waxing Services Consent Form printable pdf download

Waxing Services’ Consent Form

THIS FORM MUST BE COMPLETED & SIGNED BEFORE RECEIVING WAXING SERVICES.

General & Medical Information

Have you used any alpha-hydroxy acid or glycolic acid products in the last 48 hours? Yes No

Are you currently using any products containing Retin-A or retinol? Yes

Are you currently taking Accutane or have you taken it in the past? Yes

No How long ago?

Are you exposed to the sun on a daily basis or do you use a tanning bed? Yes No

Are you currently taking any medications? If so, please list:

Are you currently being treated for any illness / condition by a physician? If so, please list:

Have you been diagnosed with an STD within the past 90 days or are you currently experiencing an STD

outbreak? Yes No

Women: Are you currently on your menstrual cycle or due to start in the next two days? Yes No

Have you ever had a bad waxing experience? Yes No

If yes, please describe:

It is common to experience redness after waxing. In some cases, swelling or mild tenderness may also occur. It is best to

avoid all active skincare products in the waxed area for 24-48 hours. Some skincare products can exacerbate or affect the

results of waxing. It is best to allow the hair to grow for two weeks prior to waxing for a complete result. After waxing, it is

best to avoid sun exposure or overheating the area. I certify that, by completing this form: I have read the above

information and if I have any concerns I will discuss them with the esthetician. I have read and understood the waxing

precautions and am willing to follow the home care recommendations of the esthetician. I understand the waxing

procedure I am to receive and have had sufficient opportunity to discuss any questions. I understand the esthetician will

take every precaution to minimize or eliminate skin reactions. I do not hold the esthetician or Magdalen’s Pure Skin Care

liable for any skin conditions that were not disclosed at the time of waxing or any adverse effects from the waxing service.

I understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate

termination of the session. I also understand that the Esthetician reserves the right to refuse to perform waxing

services on anyone whom he/she deems to have a condition for which services is contraindicated.

Client Signature ________________________________________________ Date ______________________

NAME: ___________________________________ PHONE: ________________________________________

EMAIL: ___________________________________

Esthetician’s NAME: ________________________

Waxing Services Consent Form