Esty Skin Studio Waxing Client Consent Form
First time client details for Esty Skin Studio in Austin, Texas
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Full Name *
How did you hear about Esty?
Birthday
Full Address
Phone Number *
What areas have you been waxing before? *
If having facial waxing done, have you had any peels recently? *
Are you on Retin-A, Differin, Accutane or any blood thinning medication? *
Any recent surgery or microdermabrasion? *
Are you on your menstrual cycle? *
Do you have any warts, moles or skin irritations in the area that is to be waxed? *
Any allergies that we need to be aware of? *
Are you no more or less than 1/4 inch in growth (applies to body waxing)? *
Release of Liability
I ________________________________, for myself and my heirs, executors, administrators and assigns, hereby release, indemnify and hold harmless Esty, d/b/a, and Jessica Devon Chapman, Individually from all liability for any and all risk of damage or bodily injury or death that may occur to me (including any injury caused by negligence) in connection with any services which I participate. I likewise hold harmless from liability any other agent, representative, person, employee or entity servicing me. I will abide by all safety instructions and information provided to me during the services rendered by Esty, d/b/a and its agents, representatives, persons, employees or entities. Further, I expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by Esty, d/b/a, and f any portion thereof is held invalid, it is agreed the balance shall, notwithstanding, continue in full legal force and effect. I have no known physical or mental condition that would impair my capability to execute this Release of Liability Statement fully, as intended or expected of me.
I have carefully read the foregoing release and indemnification and understand the contents thereof. I sign this release as my own free act.

After reading the release of liability shown on the text above, please agree by clicking yes *
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