New Client Information and Consent
Welcome to REVIVAL! Please fill out the following information before your appointment. Our salon is located at 315 E Main St Suite 303 Hillsboro, OR 97123 | Call/Text: 5034278712 | Web: www.revivaloregon.com | Email: revivaloregon@gmail.com
Name *
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Address *
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Email (Receive info on monthly Specials)
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Phone *
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Are you over 18 yrs of age? *
Birthday Month/Day
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How did you hear about us?
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How would you like to receive appointment reminders and updates? *
Would you like to be featured on Instagram as part of our Before & After Series? (Lash and Brow services ONLY)
Have you had a chemical peel or used any Alpha Hydroxy Acid or Glycolic products 2-3 days prior to your upcoming waxing service? *
Are you taking any medications that may cause skin thinning? For example: Antibiotics *
Are you currently taking any medications that may effect your skin? (i.e. cause sensitivity, acne treatments, retinol topical lotions or serums.) If yes, please list: *
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Do you have any allergies to Jasmine, Lavender, Aloe, Tea Tree, Alcohol, Nut Oils or other? *
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Have you taken Accutane (or any other prescribed acne treatment) in the last 12 months? *
Please Note Waxing may cause side effects such in your skin removal/lifting, redness, swelling, tenderness, bruising, and in some cases bleeding. Skin is more sensitive the first visit. I will assess your skin prior to any services for possible contraindications. If you have any concerns? Please comment here.
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Client Consent: I will address any concerns with my Esthetician. I give permission to my Esthetician to perform the services we discuss and will hold her and her staff harmless from any liability that may result from this. I do not hold the Esthetician responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed. *
To Agree-Please type your first and last name here to consent to services at Revival Waxing Studio. *
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