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Waxing Intake Form

Copy and paste the body of your waiver here.

First Client's Name

First Name*

Last Name*

Phone*
First Client's Date of Birth*
First Client's Information

When did you last shave?

When is your menstrual cycle's start date?
Do you have or are prone to?
Ingrown Hairs
Scarring
Bumps
Hyperpigmentation
Bruising
Do you have any allergies?*
No
Yes

If yes, please list:
Are you Diabetic?*
No
Yes
Have you ever been treated for cancer?*
No
Yes
Have you used any of the following in the last 72 hours?
Retin-A
Accutane
Alpha-hydroxy Acid
Glycolic Acid
Resorcinol
Scrub or Peel
Have you used any skin thinning medications?*
No
Yes

If yes, please list:
Do you use a tanning bed?*
No
Yes
First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Second Client's Information

When did you last shave?

When is your menstrual cycle's start date?
Do you have or are prone to?
Ingrown Hairs
Scarring
Bumps
Hyperpigmentation
Bruising
Do you have any allergies?*
No
Yes

If yes, please list:
Are you Diabetic?*
No
Yes
Have you ever been treated for cancer?*
No
Yes
Have you used any of the following in the last 72 hours?
Retin-A
Accutane
Alpha-hydroxy Acid
Glycolic Acid
Resorcinol
Scrub or Peel
Have you used any skin thinning medications?*
No
Yes

If yes, please list:
Do you use a tanning bed?*
No
Yes
Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Third Client's Information

When did you last shave?

When is your menstrual cycle's start date?
Do you have or are prone to?
Ingrown Hairs
Scarring
Bumps
Hyperpigmentation
Bruising
Do you have any allergies?*
No
Yes

If yes, please list:
Are you Diabetic?*
No
Yes
Have you ever been treated for cancer?*
No
Yes
Have you used any of the following in the last 72 hours?
Retin-A
Accutane
Alpha-hydroxy Acid
Glycolic Acid
Resorcinol
Scrub or Peel
Have you used any skin thinning medications?*
No
Yes

If yes, please list:
Do you use a tanning bed?*
No
Yes
Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fourth Client's Information

When did you last shave?

When is your menstrual cycle's start date?
Do you have or are prone to?
Ingrown Hairs
Scarring
Bumps
Hyperpigmentation
Bruising
Do you have any allergies?*
No
Yes

If yes, please list:
Are you Diabetic?*
No
Yes
Have you ever been treated for cancer?*
No
Yes
Have you used any of the following in the last 72 hours?
Retin-A
Accutane
Alpha-hydroxy Acid
Glycolic Acid
Resorcinol
Scrub or Peel
Have you used any skin thinning medications?*
No
Yes

If yes, please list:
Do you use a tanning bed?*
No
Yes
Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Fifth Client's Information

When did you last shave?

When is your menstrual cycle's start date?
Do you have or are prone to?
Ingrown Hairs
Scarring
Bumps
Hyperpigmentation
Bruising
Do you have any allergies?*
No
Yes

If yes, please list:
Are you Diabetic?*
No
Yes
Have you ever been treated for cancer?*
No
Yes
Have you used any of the following in the last 72 hours?
Retin-A
Accutane
Alpha-hydroxy Acid
Glycolic Acid
Resorcinol
Scrub or Peel
Have you used any skin thinning medications?*
No
Yes

If yes, please list:
Do you use a tanning bed?*
No
Yes
Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Sixth Client's Information

When did you last shave?

When is your menstrual cycle's start date?
Do you have or are prone to?
Ingrown Hairs
Scarring
Bumps
Hyperpigmentation
Bruising
Do you have any allergies?*
No
Yes

If yes, please list:
Are you Diabetic?*
No
Yes
Have you ever been treated for cancer?*
No
Yes
Have you used any of the following in the last 72 hours?
Retin-A
Accutane
Alpha-hydroxy Acid
Glycolic Acid
Resorcinol
Scrub or Peel
Have you used any skin thinning medications?*
No
Yes

If yes, please list:
Do you use a tanning bed?*
No
Yes
Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Seventh Client's Information

When did you last shave?

When is your menstrual cycle's start date?
Do you have or are prone to?
Ingrown Hairs
Scarring
Bumps
Hyperpigmentation
Bruising
Do you have any allergies?*
No
Yes

If yes, please list:
Are you Diabetic?*
No
Yes
Have you ever been treated for cancer?*
No
Yes
Have you used any of the following in the last 72 hours?
Retin-A
Accutane
Alpha-hydroxy Acid
Glycolic Acid
Resorcinol
Scrub or Peel
Have you used any skin thinning medications?*
No
Yes

If yes, please list:
Do you use a tanning bed?*
No
Yes
Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Eighth Client's Information

When did you last shave?

When is your menstrual cycle's start date?
Do you have or are prone to?
Ingrown Hairs
Scarring
Bumps
Hyperpigmentation
Bruising
Do you have any allergies?*
No
Yes

If yes, please list:
Are you Diabetic?*
No
Yes
Have you ever been treated for cancer?*
No
Yes
Have you used any of the following in the last 72 hours?
Retin-A
Accutane
Alpha-hydroxy Acid
Glycolic Acid
Resorcinol
Scrub or Peel
Have you used any skin thinning medications?*
No
Yes

If yes, please list:
Do you use a tanning bed?*
No
Yes
Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Ninth Client's Information

When did you last shave?

When is your menstrual cycle's start date?
Do you have or are prone to?
Ingrown Hairs
Scarring
Bumps
Hyperpigmentation
Bruising
Do you have any allergies?*
No
Yes

If yes, please list:
Are you Diabetic?*
No
Yes
Have you ever been treated for cancer?*
No
Yes
Have you used any of the following in the last 72 hours?
Retin-A
Accutane
Alpha-hydroxy Acid
Glycolic Acid
Resorcinol
Scrub or Peel
Have you used any skin thinning medications?*
No
Yes

If yes, please list:
Do you use a tanning bed?*
No
Yes
Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Tenth Client's Information

When did you last shave?

When is your menstrual cycle's start date?
Do you have or are prone to?
Ingrown Hairs
Scarring
Bumps
Hyperpigmentation
Bruising
Do you have any allergies?*
No
Yes

If yes, please list:
Are you Diabetic?*
No
Yes
Have you ever been treated for cancer?*
No
Yes
Have you used any of the following in the last 72 hours?
Retin-A
Accutane
Alpha-hydroxy Acid
Glycolic Acid
Resorcinol
Scrub or Peel
Have you used any skin thinning medications?*
No
Yes

If yes, please list:
Do you use a tanning bed?*
No
Yes
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

When did you last shave?

When is your menstrual cycle's start date?
Do you have or are prone to?
Ingrown Hairs
Scarring
Bumps
Hyperpigmentation
Bruising
Do you have any allergies?*
No
Yes

If yes, please list:
Are you Diabetic?*
No
Yes
Have you ever been treated for cancer?*
No
Yes
Have you used any of the following in the last 72 hours?
Retin-A
Accutane
Alpha-hydroxy Acid
Glycolic Acid
Resorcinol
Scrub or Peel
Have you used any skin thinning medications?*
No
Yes

If yes, please list:
Do you use a tanning bed?*
No
Yes
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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