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Waxing Intake Form

Waxing Intake Form

How did you hear about us?
Have you used any chemical exfoliants (AHAs/BHAs) in the past week?
Are you using any retinol such as Retin-A, Renova, Tretinoin or Accutane?
Are you using any other skin thinning, brightening products or medications?
Do you use a tanning bed regularly?
Are you exposed to the sun on a daily basis?
Are you diabetic?

Please read and chek the following:

By signing below, I acknowledge that I have read the “Waxing Intake Form” and understand it. If I have any concerns, I will address these with my skin therapist. I give permission to my therapist to preform the wax procedure(s) we have discussed and will hold the service provider, staff, and business entity (Precise Beauty Bar) harmless from any liability that may result from this treatment.  I have given an accurate account of the questions asked above including all known prescription drugs or products I am currently ingesting or using topically. I understand my aesthetician will take every precaution to minimize or eliminate negative reactions as much as possible. 

  I am willing to follow recommendations made by my aesthetician for a home care regimen that can minimize or eliminate possible negative reactions.  In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care I will consult the aesthetician immediately.

  I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosure's. I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I have been adequately informed of the risks, benefits and alternatives to this treatment and wish to proceed with the waxing procedure. I do not hold the aesthetician, nor Precise Beauty Bar, responsible for any of my conditions that were present, but not disclosed at the time of the skin care procedure, which may be affected by the treatment performed today.  

Thanks for submitting!

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