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Consent Form
Do you have or are you prone to:
Have you ever been treated for cancer?
Have you used any of the following in the last 48 - 72 hours:
Do you use a tanning bed?

• Use of any of these medications increases the possibility of a reaction. Please inform the technician if you have begun taking any new medications since your last session.


• Please note waxing does have certain side effects such as skin removal, redness, scabbing, bruising, scarring, swelling, tenderness, pimples, ingrown hairs, and/or hyperpigmentation. Diabetes increases the risk of poor healing and infection.


• Waxing of soft tissue may cause the skin to tear resulting in the need for stitches. The most common occurrence of this is in a Brazilian Bikini Wax.



• Because of water retention and for your personal comfort, avoid hair removal two days before and after your menstrual cycle.


I have read the above information and if I had any concerns, I have addressed them with my wax technician. I give permission to my technician to perform the waxing procedure we have discussed and will hold him/her 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 prescriptions drugs or products I am currently ingesting or using topically. I understand my technician will take every precaution to minimize or eliminate negative reactions.

I have received a copy of, read, and understand the post-treatment care instructions. I am willing to follow the recommendations made by my wax technician for a home care regimen that can minimize or eliminate the possibility of a poor outcome. In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment, I will consult my technician immediately.

I agree that this constitutes full disclosure and that it supersedes any previous verbal or written statements. I certify that I have read and fully understand the above paragraphs and that I had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the wax technician performing my service responsible for any of my conditions that were present, but not disclosed at the time of this skincare procedure, which may be affected by the treatment performed today.

Thank you!

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