Waxing Form
Description
First Name *
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Last Name *
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Phone number *
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Email *
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Date of birth *
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Street Address *
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City *
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State *
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Zip *
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Would you like to receive updates on *
Have you used and Alpha Hydroxy Acid (AHA)or glycolic products in the past 48 hrs?
Are you using Retin-A, Renova or Accutane?
Are you exposed to the sun or plan on spending more time in the sun soon?
Do you use a tanning bed?
Please list you current medications.
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Are you currently being treated by a medical professional for any illness or condition?
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Have you ever had any reactions or sensitivities to waxing in the past? If so, please explain.
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How did you hear about us?
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