Waxing Consent Form | ReneeJean Make-up & Skincare

Name*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Have you used any Alpha Hydroxy Acid (AHA) or glycolic products in the past 48-72 hours?*

Yes
No
Unsure

 Are you using Retin-a, Renova or Accutane (an oral form of Retin-a)?*

Yes
No
Unsure

Are you using any other skin thinning products and/or drugs?*

Yes
No
Unsure

Are you exposed to the sun on a daily basis or are you considering spending more time in the sun soon?*

Yes
No
Unsure

Do you use a tanning bed?*

Yes
No
Unsure

Are you diabetic?*

Yes
No
Unsure

Are you currently taking medications? If so, please list all (including over the counter drugs/herbal supplements):*

Medication	Reason

What skin products do you regularly use on your skin?*

Please list any other illness/condition you are currently being treated for by a medical professional*

(Female Clients) Always allow five days for menstrual cycle. Because of water retention and for your own personal comfort, you should avoid hair removal two days before your cycle is due and two days after it is completed.

Please note that waxing does have certain side effects such as redness, swelling, tenderness, skin removal, etc. I have read the above information and if I have any concerns, I will address these with my skin therapist. I give permission to my therapist to perform the waxing procedure we have discussed and will hold her and her staff harmless from any liability that may result from this treatment. I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. I have read and understand the post-treatment home care instructions. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product / post-treatment care, I will consult the esthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures.

By digitally signing below I understand; have read and fully completed this form truthfully. I agree that this constitutes full disclosure, and that it supersedes and previous verbal or written disclosures. While all treatments are recommended to achieve the best possible results, I do understand that not all treatments will have the same results on every client, therefore no guarantee can be given. I also understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. I agree to inform the Esthetician of any skin irritation in the following days after receiving treatment. I am aware that it is my responsibility to inform the technician of my current medical or health conditions and to update this history. The treatments I receive here are voluntary and I release ReneeJean Make-up LLC & the Esthetician performing the services, from liability and assume full responsibility thereof.**