Loading...

Guest Wax Form



♡♡♡♡








WE HAVE THE RIGHT TO REFUSE ANYONE. NO-SHOWS & last minute cancellations will NOT be tolerated.


POLICY

I understand that Nude Wax Lounge has a 24 hour cancellation policy and a 10 minute grace period. 


If I cancel within the policy or 10 minutes or more late, my appointment will be cancelled and I will be charged 50% of the services booked to the card on file.


I will be blocked from booking services until I my invoice is paid.


**If you do not agree with our policy kindly find another place to service you. We appreciate your respect and support.**


HAIR REMOVAL CONTRAINDICATIONS 


**YOU MUST HAVE AT LEAST 3 WEEKS OF HAIR GROWTH FROM YOUR LAST SHAVE OR WE WILL NOT SERVICE YOU**


Waxing has certain side effects such as skin removal, redness, swelling, tenderness, pustules, acne or folliculitis.

Any medications including prescriptions, supplements, herbs and change of diet may cause changes in the skin resulting in the side effects listed above. Contraceptives may cause the skin to be sensitive to bruising and chaffing

Taking antibiotics or topical acne medications such as (but not limited to) Retinoids, Differin, Alpha Hydroxy Acids can cause skin sensitivity and skin to lift when waxed.

 *YOU MUST BE OFF ACCUTANE FOR 6 MONTHS BEFORE WAXING*

Other medication: Renova, Retin A, Retinol, Salicylic Acid, Alpha Hydroxy Acids (Glycolic, lactic), Chemical Depilatories ( Nair), Benzoyl Peroxide and Bleaching agents.                   

I have read the above information and if I have any concerns, I will address these with my Esthetician.  


 

I have given an an accurate account of the questions asked above including all known allergies, prescription medication or products I am currently ingesting or using topically.


I give permission to my Esthetician at Nude Wax Lounge to perform the waxing service and will hold her and Nude Wax Lounge harmless of any liability that may result from this treatment


.

If I have additional questions or concerns regarding my treatment or post treatment care I will contact Nude Wax Lounge immediately.


.

I agree that this constitutes full disclosure, and that is supersedes any previous verbal or written disclosures. 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.



PRE- APPOINTMENT CHECKLIST:

  • Stop shaving at least 3 WEEKS before your wax
  • Exfoliate with a scrub the night before your appointment
  • Come to your appointment freshly showered with clean skin
  • Let us know if you are on any medication that could affect your wax
  • Take an antihistamine before your appointment (Benadryl)


Thank you for supporting a small locally women-owned business, we are so thankful and can’t wait to wax you 

♡♡♡♡

 













First Guest Name

First Name*

Last Name*

Phone*
First Guest Date of Birth*
First Guest Signature*
Second Guest Name

First Name*

Last Name*
Second Guest Date of Birth*
Second Guest Signature*
Third Guest Name

First Name*

Last Name*
Third Guest Date of Birth*
Third Guest Signature*
Fourth Guest Name

First Name*

Last Name*
Fourth Guest Date of Birth*
Fourth Guest Signature*
Fifth Guest Name

First Name*

Last Name*
Fifth Guest Date of Birth*
Fifth Guest Signature*
Sixth Guest Name

First Name*

Last Name*
Sixth Guest Date of Birth*
Sixth Guest Signature*
Seventh Guest Name

First Name*

Last Name*
Seventh Guest Date of Birth*
Seventh Guest Signature*
Eighth Guest Name

First Name*

Last Name*
Eighth Guest Date of Birth*
Eighth Guest Signature*
Ninth Guest Name

First Name*

Last Name*
Ninth Guest Date of Birth*
Ninth Guest Signature*
Tenth Guest Name

First Name*

Last Name*
Tenth Guest Date of Birth*
Tenth Guest Signature*
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*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Skin Contraindications
Are you currently taking an oral contraceptive or have a contraceptive implants?*
No
Yes
Do you have any allergies? This includes food, medication, metals and materials.*
No
Yes

If you answered yes above, please list all allergies.
Do you use tanning beds and/or are exposed to the sun on a regular basis?*
No
Yes
Do you have any open skin lesions?*
No
Yes
Are you using Retin A, Renova or Accutane (oral or topical)?*
No
Yes
Have you used any Alpha Hydroxy Acids (AHA), glycolic or salicylic acid products within the last 3 days?*
No
Yes
Are you using any other skin thinning products and/or medications? Oral & Topical?*
No
Yes

If you answered yes above, please list the medications.
Are you currently taking any other medications? Oral & Topical?*
No
Yes

If you answered yes above, please list any other medications you are currently ingesting or applying topically
Are you currently or have been in the past treated for any illnesses?*
No
Yes

If you answered yes above, please list any illness/conditions which you are being treated for by a medical professional. (Current and past)

IF UNDER 16 YEARS OF AGE A PARENT MUST BE PRESENT AT APPOINTMENT

Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 16 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.







By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

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


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!