Karen at Salon Suites
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Waxing Consent Form
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Thank you
First name
(required)
Last name
(required)
Cell Phone number
(required)
Email Address
(required)
Have you ever been waxed before?
(required)
Yes
No
If so, have you ever had a bad reaction?
Yes
No
If so, please explain:
Have you received a Botox treatment within the last 72 hours?
(required)
Yes
No
Have you been, or plan to be in the sun or a tanning bed (within 24 hours)?
(required)
Yes
No
Have you had, or plan to have a professional exfoliating service, like a chemical peel, dermaplaning, or microdermabrasion (within two weeks)?
(required)
Yes
No
Are you diabetic?
(required)
Yes
No
Are you currently using or taking any of the following?
(required)
Blood thinners
Antibiotics
Steroids (like Tetracycline)
Retinol
OTC products targeting acne or blemished skin, fine lines or wrinkles, and/or hyperpigmentation (dark/sun spots)
Prescriptions targeting any skin concerns or conditions
Have you ever used or taken any of the following?
(required)
Retinoids like Retin-A and Differin
Accutane or other prescription skincare
Known allergies:
(required)
Extra Comments:
By checking this box, I verify that I filled out this form honestly and I take on any liability.
(required)
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