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WAXING & PLUCKING CLIENT CONSULTATION FORM

-personal & confidential-

WAXING & PLUCKING CONSENT AGREEMENT

Waxing and plucking are both hair removal methods achieved by the use of wax and tweezers to remove the hair from the root.

I understand and acknowledge that I am of the full age of 18 years or older. If below 18 years of age a parent or guardian must also sign this form. I confirm that I am not under the influence of alcohol or any illicit or prescription drugs which would in any way impair my ability to agree to the terms of this agreement or safely commence the procedures herein. This agreement will remain in effect for this procedure and all future procedures conducted by my technician or any other technician conducting business at Refined by Riley I understand that this agreement is binding and that I have read and fully understand all information above.

WAXING & PLUCKING CONTRAINDICATIONS

A contraindication is a condition that labels the client as unfit for this treatment. Please consult with me before the procedure if you have any of the following:

PLEASE READ AND SIGN, CONSENTING THAT NONE OF THESE APPLY TO YOU

WAXING IS NOT RECOMMENDED FOR CLIENTS OF ARE OR HAVE ANY OF THE FOLLOWING:

  1. Recent sunburn or tanning.
  2. Recent use of certain medications, such as Accutane.
  3. Skin conditions like psoriasis, eczema, or dermatitis.
  4. Open wounds, cuts, or abrasions on the skin.
  5. Recent cosmetic or reconstructive surgery in the waxing area.
  6. Allergies to wax or its components.
  7. Use of certain skincare products containing retinoids or alpha hydroxy acids.
  8. Pregnancy, especially in sensitive areas.
  9. Certain medical conditions like diabetes or circulation problems.
  10. Immunocompromised individuals or those with a weakened immune system.
  11. History of adverse reactions to waxing.
  12.  Certain blood thinners.

WAXING AFTERCARE

1. Avoid Sun Exposure: refrain from direct sun exposure, tanning beds, or sunbathing for at least 24-48 hours post-waxing to prevent skin irritation.

2. Avoid Hot Baths or Showers and Sweating: skip hot baths, showers, saunas, or steam rooms for the first 24 hours after waxing to reduce the risk of irritation or infection.

4. Avoid Touching Treated Area: refrain from touching the waxed area with unwashed hands to minimize the risk of infection.

5. Only use gentle products- avoid exfoliation for first 48 hours, cleanse the treated area gently with a mild, fragrance-free cleanser and moisturizer to prevent irritation. Avoid harsh or scented products..

6. No Makeup on Facial Areas: refrain from applying makeup on freshly waxed facial areas to prevent clogging pores.

7. Avoid Swimming: avoid swimming in chlorinated pools, hot tubs, or natural bodies of water for at least 24 hours to reduce the risk of infection.

8. No Chemical Products: avoid using chemical-based products, such as self-tanners or perfumes, on the waxed area for at least 24 hours.

I Agree


I UNDERSTAND / AGREE TO THE FOLLOWING COMPLETELY

I give permission to Refined by Riley to perform the waxing procedure and we have discussed and will hold them harmless from any liability that may result from this treatment.

I Agree

Waxing is a method of temporary hair removal which removes the air from the root. I understand that waxing may have some side effects including redness, scabbing, bruising, swelling, tenderness, flaking/ or pimples. If I experience a medical conditions, I will contact Refined by Riley and consult a physician at my own expense. 

I Agree

I release Refined by Riley from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that Refined by Riley has been professionally trained to use.

I Agree

I agree to adhere to all post treatment after care including no peels, tanning, saunas for 72 hours after waxing; and all home protocols recommended by Refined by Riley that can minimize or eradicate possible negative reactions.

I Agree

By signing below, I verify that I have read and understand the above statements and agree to them.

PHOTOGRAPHIC, AUDIO, OR VIDEO RECORDINGS MAY BE USED FOR THE FOLLOWING PURPOSES:

I hereby grant permission to the rights of my image, likeness, and sound of my voice as recorded in audio or video tape without payment or any other consideration.

I understand that my image may be edited, copied, exhibited, published, or distributed. I waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any rights to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.

PHOTOGRAPHIC, AUDIO, OR VIDEO RECORDINGS MAY BE USED FOR THE FOLLOWING PURPOSES:

-Educational presentations or courses

-Informational presentations

-Online educational courses

-Educational videos

-Promotional materials

By signing this release, I understand the permission signifies that photographic or video recordings of me may be electronically displayed via internet

By signing this form, I acknowledge that I have completely read and fully understand the above release and agree. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
How did you hear about us?

How did you hear about us? *
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.


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*

Middle Name

Last Name*

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.


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