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Client Consent Waxing

Thank you for taking a few minutes of your time to complete our Client Intake Form. This form helps us give you information that we think will be beneficial. If you have any questions as you work your way through the form, please do not hesitate to ask.

Terminology

The words “I”, “you” and “your" are used interchangeably throughout this agreement and in all cases refer to you the client who is receiving the aesthetic service.

“Service" includes any of the processes performed on you by a practitioner or technician, namely those listed on the price sheet on display at reception or as listed on the services section of our website at https://www.ivonnesanchez.com/services-fees.

“Practitioner”, “technician”, “instructor” and “we” means 10981508 CANADA INC. dba “Ivonne Sanchez Beauty”, its owners, staff or contractors.

Waxing Informed Consent

Waxing involves the use of warm wax (or sugar) applied to the skin with a single-use applicator (e.g., cloth strip, spatula, roller cartridge). A disposable cloth strip is pressed onto the wax and rapidly pulled away from the skin to remove the hairs. 

Infection risk: Waxing may result in compromised skin and increased risk of mucous membrane exposure, heightening the risk of infection. The potential sources of infections are: 

  • Contaminated and improperly disinfected equipment (e.g., product contamination).
  • Contaminated environment.
  • Client’s own bacteria that spread to the wound.
  • Unclean hands touching the treatment area. 

Infections can be bacterial (e.g., Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa), fungal (e.g., Candida spp., Aspergillus spp.), or viral (e.g., herpes simplex virus).86 An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection has also been reported. Personal service providers are to inform clients about the risks of waxing when taking anti-acne medication, as this may increase risk of infection by damaging the skin and potentially removing the epidermis (top layer of the skin).

I understand that there may be a certain amount of discomfort or pain associated with the procedure and that other adverse side effects may include minor and temporary bleeding, bruising, redness or other discolouration and swelling.  Though uncommon, it is possible for the skin to tear if already thin, especially if the client is taking certain medications.

I acknowledge that by signing below that I have been given the full opportunity to ask any and all questions which I might have about obtaining body waxing or sugaring procedures from Ivonne Sanchez Beauty or any staff or contractor. I also acknowledge that all of my questions have been answered to my full and complete satisfaction (or will have been fully answered before proceeding with any service). I specifically acknowledge that I have been advised of the fact and matters set out below, and I agree as follows:

  1. I acknowledge that it is not reasonably possible to determine whether I might have an allergic reaction to any of the products that may be used in our services including but not limited to wax, topical preparations, powders, adhesives, cleaning solutions, or processes used in the procedure; and I agree to accept the risk that such a reaction is possible. I have and will remind the practitioner of any existing sensitivities now and in the future, especially if there have been any changes to sensitives or reactions. I acknowledge that any product containing chemicals or preservatives poses a risk of irritation.
  2. I acknowledge that complications are possible as a result of the service, particularly where precare, aftercare, or best practices are not followed.
  3. I understand that Ivonne Sanchez Beauty and its practitioners are not obligated to provide service to me if my health is compromised or the areas of service are not ideal for performing the same. This includes open, broken or bruised skin or tissue, or signs of infection.
  4. I understand that it is up to me to plan my aesthetic service according to events in my own personal schedule and that Ivonne Sanchez Beauty cannot be expected to perform services under unrealistic timelines e.g. last minute service due to meetings, professional obligations etc.
  5. I understand that where I am receiving service for the first time from a "new" technician that it is my responsiblity to communicate and work with that technician in order to achieve the desired outcome. I further understand that building an ongoing service relationship with my technician leads to higher success rates and overall service satisfaction.
  6. I understand that timing is criticaly important and that Ivonne Sanchez Beauty will do everything possible to also uphold my appointment times but that Ivonne Sanchez Beauty will not be held responsible for any delays in start or finish times, however we will work together with you to always resolve any practical concerns.
  7. I have received and read a copy of the aftercare Instructions (where applicable).
  8. I understand that if I am receiving services at a discounted rate e.g. as a model in the beauty training program, that the service times and work product will not be the same as a regular service and that I am willing to work with the business or the trainee to support their learning.

I have read and understand the contents of this consent form.

Cancellation and Booking Policy

All new clients must make their first booking online by creating an online account, completing their contact information and securely entering their credit card information which is stored in encrypted and in masked format.
All bookings are recorded in our online booking system. This system will send an e-mail confirmation to you of your scheduled appointment at the time that the scheduling is made. The booking system will also send a follow-up reminder e-mail 24 hours prior to your scheduled appointment. Unfortunately, we do not have a telephone reminder service.
Any client that has registered incorrect information or has unsubscribed from e-mail or telephone reminders is fully responsible for any missed or late appointment.
 

A $100 + tax deposit may be required in order to make a booking for select services (namely those over 2 hours or approximately $200 in value). This will be applied to your scheduled service subject to the cancellation policy.

All cancellations and appointment rescheduling requests must be made at least 24 hours prior to the start of your scheduled appointment time, otherwise subject to a cancellation fee of 50% of the service.

The following events will result in the loss of the $100 + tax booking deposit:

  1. No-shows;
  2. Cancellations without a minimum of 24 hours notice; or
  3. Cancellations with 24 hours notice but where a new booking is not made

I understand that repeat or excessive reschedulings may result in a request for 100% deposit for future services and that after 3 successive rescheduling for the same or similar service may result in loss of service.

I agree that should I be asked to provide such deposits that I will not circumvent the request by creating new or duplicate client accounts.

I acknowledge that being on time is my responsiblity alone and that arriving 10 minutes late or more may result in the cancellation of my appointments and forfeiting any deposit and or having my credit card on file charged.

I acknoweldge that IVONNE reward points for bookings will only be awarded if I place my booking online through book.ivonnesanchez.com and that rewards for prebooking are only eligible for bookings made while I am at the salon.

I understand and agree to the above cancellation and scheduling policy.

Customer Satisfaction and Feedback.

If I am unhappy with the results or service, I will not immediately take to the internet to air my grievances of Ivonne Sanchez Beauty (its staff, contractors or owners) in any online forum including but not limited to: Google Reviews, Facebook Reviews, BBB, Instagram, Facebook, or Twitter. I will instead contact Ivonne privately in order to allow her to work with me to find a solution. I understand that my review should be a summary of the complete experience including resolution, that review platforms are not for negotiating service issues.

I understand that I will confirm the price of service with my technician before proceeding.

I Agree

I understand that all service sales are final and all opened products sales are also final. No refunds will be issued under any circumstances and I agree not to request or pursue a chargeback from my bank or credit card company. Instead, I will contact Ivonne privately and arrange for a mutually acceptable resolution.

I understand that rude or aggresive behavior will not be tolerated and that the use of profanity is not appropriate for our environment.

Today's Date: July 3, 2020

All information is collected by Ivonne Sanchez Beauty pursuant to O. Reg. 136/18: PERSONAL SERVICE SETTINGS and The Personal Information Protection and Electronic Documents Act (“PIPEDA “).

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Age

How you found us:

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Face
Neck
Arms
Bottom
Abdomen
Legs
Bikini Area
Chest
Feet
Hands

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you sensitive to Latex or Nitrile?*
No
Yes
Do you have problems with healing?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you taking Accutane or any medications that cause the skin to become thin? (This is a contravention for Waxing as it causes the skin to tear or rip easily).*
No
Yes
Have you had a facial peel in the last few days?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).

What is the date of service: *

What service is being received?: *

What is the cost of the service? *
First Participant's Signature*
Second Participant's Name

First Name*

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

Age

How you found us:

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Face
Neck
Arms
Bottom
Abdomen
Legs
Bikini Area
Chest
Feet
Hands

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you sensitive to Latex or Nitrile?*
No
Yes
Do you have problems with healing?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you taking Accutane or any medications that cause the skin to become thin? (This is a contravention for Waxing as it causes the skin to tear or rip easily).*
No
Yes
Have you had a facial peel in the last few days?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).

What is the date of service: *

What service is being received?: *

What is the cost of the service? *
Third Participant's Name

First Name*

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

Age

How you found us:

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Face
Neck
Arms
Bottom
Abdomen
Legs
Bikini Area
Chest
Feet
Hands

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you sensitive to Latex or Nitrile?*
No
Yes
Do you have problems with healing?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you taking Accutane or any medications that cause the skin to become thin? (This is a contravention for Waxing as it causes the skin to tear or rip easily).*
No
Yes
Have you had a facial peel in the last few days?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).

What is the date of service: *

What service is being received?: *

What is the cost of the service? *
Fourth Participant's Name

First Name*

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

Age

How you found us:

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Face
Neck
Arms
Bottom
Abdomen
Legs
Bikini Area
Chest
Feet
Hands

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you sensitive to Latex or Nitrile?*
No
Yes
Do you have problems with healing?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you taking Accutane or any medications that cause the skin to become thin? (This is a contravention for Waxing as it causes the skin to tear or rip easily).*
No
Yes
Have you had a facial peel in the last few days?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).

What is the date of service: *

What service is being received?: *

What is the cost of the service? *
Fifth Participant's Name

First Name*

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

Age

How you found us:

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Face
Neck
Arms
Bottom
Abdomen
Legs
Bikini Area
Chest
Feet
Hands

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you sensitive to Latex or Nitrile?*
No
Yes
Do you have problems with healing?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you taking Accutane or any medications that cause the skin to become thin? (This is a contravention for Waxing as it causes the skin to tear or rip easily).*
No
Yes
Have you had a facial peel in the last few days?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).

What is the date of service: *

What service is being received?: *

What is the cost of the service? *
Sixth Participant's Name

First Name*

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

Age

How you found us:

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Face
Neck
Arms
Bottom
Abdomen
Legs
Bikini Area
Chest
Feet
Hands

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you sensitive to Latex or Nitrile?*
No
Yes
Do you have problems with healing?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you taking Accutane or any medications that cause the skin to become thin? (This is a contravention for Waxing as it causes the skin to tear or rip easily).*
No
Yes
Have you had a facial peel in the last few days?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).

What is the date of service: *

What service is being received?: *

What is the cost of the service? *
Seventh Participant's Name

First Name*

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

Age

How you found us:

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Face
Neck
Arms
Bottom
Abdomen
Legs
Bikini Area
Chest
Feet
Hands

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you sensitive to Latex or Nitrile?*
No
Yes
Do you have problems with healing?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you taking Accutane or any medications that cause the skin to become thin? (This is a contravention for Waxing as it causes the skin to tear or rip easily).*
No
Yes
Have you had a facial peel in the last few days?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).

What is the date of service: *

What service is being received?: *

What is the cost of the service? *
Eighth Participant's Name

First Name*

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

Age

How you found us:

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Face
Neck
Arms
Bottom
Abdomen
Legs
Bikini Area
Chest
Feet
Hands

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you sensitive to Latex or Nitrile?*
No
Yes
Do you have problems with healing?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you taking Accutane or any medications that cause the skin to become thin? (This is a contravention for Waxing as it causes the skin to tear or rip easily).*
No
Yes
Have you had a facial peel in the last few days?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).

What is the date of service: *

What service is being received?: *

What is the cost of the service? *
Ninth Participant's Name

First Name*

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

Age

How you found us:

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Face
Neck
Arms
Bottom
Abdomen
Legs
Bikini Area
Chest
Feet
Hands

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you sensitive to Latex or Nitrile?*
No
Yes
Do you have problems with healing?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you taking Accutane or any medications that cause the skin to become thin? (This is a contravention for Waxing as it causes the skin to tear or rip easily).*
No
Yes
Have you had a facial peel in the last few days?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).

What is the date of service: *

What service is being received?: *

What is the cost of the service? *
Tenth Participant's Name

First Name*

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

Age

How you found us:

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Face
Neck
Arms
Bottom
Abdomen
Legs
Bikini Area
Chest
Feet
Hands

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you sensitive to Latex or Nitrile?*
No
Yes
Do you have problems with healing?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you taking Accutane or any medications that cause the skin to become thin? (This is a contravention for Waxing as it causes the skin to tear or rip easily).*
No
Yes
Have you had a facial peel in the last few days?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).

What is the date of service: *

What service is being received?: *

What is the cost of the service? *
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
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*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Age

How you found us:

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Face
Neck
Arms
Bottom
Abdomen
Legs
Bikini Area
Chest
Feet
Hands

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you sensitive to Latex or Nitrile?*
No
Yes
Do you have problems with healing?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you taking Accutane or any medications that cause the skin to become thin? (This is a contravention for Waxing as it causes the skin to tear or rip easily).*
No
Yes
Have you had a facial peel in the last few days?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).

What is the date of service: *

What service is being received?: *

What is the cost of the service? *
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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