Waxing Waiver Form

First Name

Last Name

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Age ?

Have you used any Alpha Hydroxy Acids (AHA) or glycolic products in the past 48-72 hours?

Yes

Have you used Retin-A, Renova, or Accutane within the past year?

Yes

Are you using any other skin thinning products and/or drugs that thin the blood?

Yes

Do you use tanning beds and/or are exposed to the sun on a regular basis?

Yes

Are you currently taking any medications? If so, please list.

Have you been treated for cancer? If yes, when and what types of therapies were used?

Please list any illness/conditions which ou are currently being treated for by a medical professional.

Do you have any open skin lesions?

Yes

Do you have any allergies?

Yes

Please note that waxing can have certain side effects such as skin removal, redness, swelling, tenderness, etc.

I have read the above information and have given an accurate account of the questions and if I have any concerns, I will address these with my Esthetician. I give consent to receive the Waxing Waiver Form – Form Preview m the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment. I agree to adhere to all safety post care including: no peels, tanning, or wet room services; no swimming/spas/hot tubs for 72 hours after waxing; and all home skin care protocols as recommended by my service provider. I understand that my Esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.

Date / Time

Signature

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