Waxing Consent and Questionnaire
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Email *
Your name (First & Last) *
Date of Birth *
MM
/
DD
/
YYYY
Phone Number *
How did you hear about us? *
When did you last shave the area being waxed, if applicable?
Do you have/are you prone to...ingrown hairs, scarring, bumps, hyperpigmentation, bruising, are you diabetic, have you been treated for cancer? *
Required
Are you allergic to anything?
If yes, please list all things you have allergies to.
Have you used any of the following in the last 5 days? *
Required
Are you currently taking, or have you taken Accutane in the last 6 months? *
Or any other oral acne medication.
Do you use a tanning bed? If so how often?
Have you had any botox or fillers in the last 72 hours? If so, where?
I consent for photographs to be taken and used for advertisement purposes, including but not limited to website, social media, local ads. *
Required
By typing your name below you agree that you fully understand all the questions above and have answered them all correctly and honestly. I understand that the esthetician will completely inform me of what to expect in the course of treatment and will recommend adjustments to my regimen if deemed necessary. I also am aware that individual results are dependent upon my age, skin condition, and lifestyle. I agree to actively participate in following appointment schedules and home care procedures to the best of my ability, so that I may obtain maximum effectiveness. In the event that I may have additional questions or concerns regarding my treatment or suggested home product routine, I will inform my esthetician immediately. I release and hold harmless the esthetician, Maggie Guy at Naked Aesthetics, harmless from any liability for adverse reactions that may result from this treatment. I have read and understand all of the foregoing information. *
If you are under the age of 16 please have a parent consent to the above agreements by typing their name below.
If you are filling this out on behalf of someone else, please make sure that their name is at the top of this form and they also agree to the above statements and have answered every question to the best of their knowledge. Please put your name below (person filling out the form on behalf of someone else).
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