Waxing Consent Form
ELKE VON FREUDENBERG SALON 1140 BROADWAY NY NY 917 475 6845 salon@elkevonfreudenberg.com
Email address *
Full Name *
Your answer
Phone *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
What facial part(s) are we waxing today? *
Required
Do you have or you prone to | Ingrown Hairs *
Scarring *
Hyperpigmentation *
Bumps *
Bruising *
Allergies *
Are you diabetic? *
Have you ever been treated for cancer? *
Please note if yes to the following, appointment must be made 2 weeks after discontinuing of use.
Your answer
Have you used any of the following the last 48-72 hours? | Accutane *
Retin- A *
Alpha-hydroxy Acid *
Glycolic Acid *
Resorcinol *
Scrub or Peel *
Have you used other skin thinning medications? If so, which?
Your answer
Do you use a tanning bed? *
Any other illness/conditions you are presently being treated for by a medical professional?
Your answer
Consent *
Captionless Image
Required
Consent *
Captionless Image
Required
I authorize Elke Von Freudenberg Salon to perform the Facial Waxing procedure. I understand the waxing procedure is as follows above: *
CONSENT: Client Full Name *
Your answer
Date *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google.