Waxing Release Form
Name *
Your answer
Phone *
Your answer
Email *
Your answer
Have you recently used any AHA or glycolic products within the last 48-72 hours? *
Required
Are you using Retin-a, Retinol, Renova or Accutane or any other oral version of Retin-a? *
Required
Are you on any other skin thinning drugs or products (this includes antibiotics & vitamin C treatments)? *
Required
Have you recently been or plan on being exposed to the sun or UVA/B rays? This includes tanning beds. *
Required
Have you recently undergone any of the following treatments within the last 3-6 months? *
Do you have a pacemaker? *
Required
Do you have allergies or senstivities to the following? *
I am at least 18 years of age. If not, I have parental permission to receive waxing services. *
Required
By checking the box below, I am acknowledging that I have read, understand and answered the waxing release form to the best of my knowledge and abilities. *
Required
I acknowledge that waxing can result in: hives, redness and tenderness of the skin for up to 24 hours after service is performed. I also acknowledge that if I am on any of the skin/blood thinning topical or oral products listed above waxing may result in lifted skin and extended irritation. *
Required
I do not hold Carly Jaeger, Kiss & Makeup or it's employees responsible for any of my conditions or medications that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today. I release the above from any damages resulting because of this. *
Required
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