Wax Questionnaire
Personal Information
Let's start with the basics.
Contact & Referral
How can we best keep in touch?
Today's Service
Tell us about what you're getting done today.
Skin Conditions
Please tap YES or NO for each of the following.
Products & Medications
Are you currently using or taking any of the following?
Medical Information
Your privacy matters. All information is strictly confidential.
Skin Imperfections
Are there any minor skin imperfections you'd like treated today? Tap all that apply.
(barnacles)
Waiver & Consent
Please read each statement carefully, then enter your initials to confirm.
Waxing may cause bruises, scabs, scarring, redness, hyperpigmentation, pimples, or a flare-up of any of the above mentioned conditions. Waxing of soft tissue may cause the skin to tear, resulting in the need for stitches. (Most common in Brazilian Bikini waxes, male or female.)
I understand that if I have Herpes or Staph/MRSA, I may experience an outbreak after the waxing service. The professional has explained the best way to minimize or prevent an outbreak when waxing regularly.
I understand I may carry Herpes and/or Staph/MRSA without any physical symptoms or a medical diagnosis. I also understand that the waxing service does not allow the opportunity to contract these conditions from my technician.
I understand all of the above mentioned reactions. I also understand that if I change my skin care routine or medications, I must inform the professional PRIOR to any future service.
I understand that I must be showered and prepared for my service.
I understand that if I cancel or miss my appointment within the 24-hour cancellation policy, I will be charged $25.00 or HALF of the service fee, whichever is greater.
Signature
Please print your name and sign below to complete your form.
Sign above using your finger or stylus
Thank You!
Your form is complete. Please hand the iPad back to Stephanie — she'll take wonderful care of you!
Service History
Record visit details below. Tap "Add Visit" to log additional appointments.