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Intake authorization and consent
First name
Last name
Email
Date of Birth
Have been using any retinol or AHA or BHA products in the last seven days. Retin A, Renova, Differin, Salicylic Acid, Glycolic Acid, Tazorac, Proactive, etc. All of these mentioned can enhance skin sensitivity that can lead to lifting of the skin.
No
Yes
Are you currently using Accutane? If no have you used with-in past year?
No
Yes
I understand waxing is not recommended for anyone with a weakened immune system such as but not limited to diabetes, or are anyone currently undergoing treatments for cancer.
No
Yes
Do you have rosacea, eczema, psoriasis, cracked or open skin, severe varicose veins, or any skin sensitivities? Have you used a tanning bed or experienced prolonged sun exposure within the past 24 hours?
No
Yes
I declare that the info I’ve provided is accurate & complete
I hereby acknowledge this release from liability for accidental injury I may incur as a result of consenting to hair removal by way of waxing. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my ailments, or contraindications which may cause further complications during my service/treatment and there after. I read and understand Wax Happy LLC's Authorization & Consent form. Clicking the box provided I agree to the information within the Authorization & Consent form.
Authorization & Consent
Signature & initails
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