Waxing Consent Form
Please take a moment to carefully read all information to help us give you the best results from your treatment.
If you are currently taking Accutane or have in the past 6 months you should avoid waxing. If you are suffering from Diabetes, varicose veins, or poor circulation we do not recommend waxing. Inform your esthetician if you have used Retin-A, Renova, Differin, Tazorac or any other skin thinning medication in the past 2 months. Inform your esthetician if you have used Alpha-hydroxy Acid, Glycolic Acid or antibiotics (oral or topical) in the past 48 hours.
Use of any of the medications listed above increases the posibility of a reaction. Please inform your esthetician if you have begun taking any new medications since your last appointment.
Please note waxing does have certain side effects such as skin removal, redness, scabbing, brusing, scarring, swelling, tenderness, hyperpigmentation, and/or pimples.
I have read the above information and if I have any concerns I will address them with my esthetician. I give permission to perform the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment. I understand my esthetician will take every precautuion to minimize or eliminate negative reactions.
I am willing to follow the recommendations made by my esthetician for a home care regimen that can minimize or possible eliminate 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 my esthetician immediately.
I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosure. I certify that I have read and fully understand the above paragraphs. I understand the procedure and accept the risks. I do not hold the esthetician responsible for any of my conditions that were present, but not disclosed at the time of this skin procedure, which may be affected by the treatment performed today.
Client Name (print) ______________________________________________________________________________
Client Signature ______________________________________________________________________________ Date:_________________
Client Name (print) ______________________________________________________________________________
Client Signature ______________________________________________________________________________ Date:_________________
Client Name (print) ______________________________________________________________________________
Client Signature ______________________________________________________________________________ Date:_________________
Client Name (print) ______________________________________________________________________________
Client Signature ______________________________________________________________________________ Date:_________________
Client Name (print) ______________________________________________________________________________
Client Signature
