waxing Consent Form
List area to be waxed
Please check mark if you have used any of these products in the last 48-72 hrs. All information is fully confidential and is only used so that your Esthetician can provide the safest and most comfortable treatment possible.
Alpha Hydroxy Acid (AHA)
Scrub or Peel
Check if you have or prone to?
Medications, OTC, and Vitamins
Do you have health problems your Esthetician needs to know about? If so what are they?
Possible side effects include, but are not limited to: mild redness, extreme redness,bruising,local swelling, stinging, tenderness, dry skin, flaking, scabbing, lightening or darkening of the skin, infections, pimples, bumpy appearance, and cold sores. most side effects are temporary and generally fade within 72 hrs. Do you understand?
I do not have open lesions or active herpes outbreaks(cold or genital)
yes I do
No I dont
I uderstand that any kini or brazillian waxing cannot be done while on menstral cycle, due to sanitation purpose and protection of myself and Esthetician.
I have not tanned or plan on tanning within 24hrs from my wax
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