Request edit access
Waxing Consent Form
Please complete and submit.
Sign in to Google to save your progress. Learn more
First and last name: *
Date of procedure *
MM
/
DD
/
YYYY
Date of birth: *
MM
/
DD
/
YYYY
Are you currently using a Retin-A? *
If you answered yes, how many days since your last Retin-A use?
Are you currently taking any medications that make you photosensitive (skin sensitive to sun)? *
Are you currently sunburned? *
Do you currently have or have you had any of the following medical conditions that could compromise your skin and/or services being offered?
I understand that I may experience skin sensitivity/thinning, which can result in skin lifting, from sunburned skin, pregnancy, menstruation, retinol, antibiotics, certain medical conditions or other medications. *
I understand that if I begin use, or are currently using, any products such as Accutane, Renova, Tretinoin, Adapalene, Alustra, Avage, Isotretinoin, Avita, Differin, Retin-A or Tazarotene and do not inform the esthetician prior to current or future treatments, I accept full responsibility for any adverse reactions. *
I understand that waxing may cause some redness, bumps, soreness, and/or itching. *
Please type your full name below to confirm that you understand and accept these liabilities and policies. *
*
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy