Wax Consultation Form
Name & Date
Contact Phone Number and Email (My system sends out appointment reminders for you & special savings)
Which form of communication is best for you? I’d love to keep you in the loop with monthly specials, sales , new products/ services & fun business updates!
I'd love any of these communications!
Address, City, State, Zip (I occasionally send out happy mail)
Emergency Contact & Phone Number
Your Birthday Month/Day
How did you hear about Kendra Renee Holistic Skin Nutrition & Expert Waxing?
Referral - If someone referred you, please write their name in the short answer box in the bottom.
Have you ever been waxed before? If yes, when?
(If applicable) When is your menstrual cycle due? *for your own comfort, it is best not to wax 2 days before, during, and 2 days following your menstrual cycle.
Do you have any tendencies towards: Ingrown hairs, break outs, bumps, hyperpigmentation, bruising, scarring, eczema, psoriasis? If yes, please note.
The more I know, the better your results and the better I can serve you. Have you had or do you use any of the following (if yes, please note date.): Microdermabrasion, botox, fillers, laser resurfacing, LED light therapy, removal of skin cancer, active cancer, chemotherapy, tetracycline, isotretinoin/accutane, Retin-A, aplha or beta hydroxy acids, resorcinol, at home scrubs/peels, indoor tanning, hydroquinone,herpes, staph, MRSA, allergies, etc.
What did you LOVE about your last waxing experience, and what could you have lived without?
Knowing that home care is a big part of achieving beautiful & healthy skin after waxing, would you like to chat about how to maintain today's results and have the best waxing experience?
Yes, give me the scoop!
Nope, just rip the hairs out, please!
Please read carefully and initial the following by checking each box.
Waxing may cause bruises, scabs, scarring, redness, hyperpigmentation, pimples or a flare up of any of the conditions mentioned above
Waxing of soft tissue may cause the skin to tear resulting in the need for stitches (most common in Brazilian waxing. In my thousands of times performing this service it has NEVER happened but I must disclose possibility due to insurance purposes).
I understand that if I have Herpes and/or Staph/MRSA, I may experience an outbreak after the waxing service.
I understand I may carry Herpes and/or Staph/MRSA without any physical symptoms or a medical diagnosis
I understand that the waxing service does not allow the opportunity to contract these conditions from my Esthetician.
I understand that if I change my skincare routine or medications I must inform my Esthetician PRIOR to any future service. I understand that there shall be no liability on the Estheticians part should I fail to do so.
I understand that I must be clean and prepared for my service
Anything else you want to share? I love learning about my clients as it helps me provide superior customer service.
By hitting submit, you acknowledge that you are virtually signing your name.
A copy of your responses will be emailed to the address you provided.
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