Waxing Intake & Concent Form

HOME
SERVICES
POLICIES
ABOUT
- MEET THE OWNER
- CONTACT
SHOP
GIFT CARDS
EVENTS
More

Use tab to navigate through the menu items.

Waxing Intake

Welcome to Beauty Journey!
We're so glad you're here! Please complete the Client Intake Form accurately so we can personalize your experience. Your information is confidential and helps us serve you best. Thank you—we can’t wait to pamper you on your Beauty Journey!

First name

Last name

DOB

Address

How did you hear about us? * Required

Referral

Google

Instagram

Facebook

None

Phone

If referred, please list their name.

Contact Information

Let's Unveil Your Smooth Skin!

At Beauty Journey ALL SKIN IS BEAUTIFUL!

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

Yes

Not Sure

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

Yes

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

Chemical Peel

Microdermabrassion

Laser

None

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

Yes

Do you use a tanning bed? *

Yes

Are you diabetic? *

Yes

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

Have you ever been treated for cancer? If yes, when and what types of therapies were used?

(Female clients) When is your next menstrual cycle due to begin?______ (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.)

Waxing Consent & Acknowledgment:

I understand that waxing may cause temporary side effects such as redness, tenderness, swelling, or skin removal. I have disclosed all relevant medical history, allergies, and medications, and give my esthetician permission to perform the discussed waxing treatment. I’ve read and understand the post-care instructions and agree to follow the recommended home care to reduce the risk of irritation. I understand that my esthetician will take all necessary precautions for my safety. I understand that a valid card is required to remain on file. I agree that 100% of the service fee will be charged for no-shows or cancellations with less than 24 hours’ notice.

This consent serves as full disclosure and overrides any prior agreements. I release my esthetician and staff from liability for any pre-existing conditions not disclosed that may be affected by today’s treatment.

Selec all that may apply to you: *

AIDS/HIV

HEPATITIS

VAROCOSE VEINS

ECZEMA/PSPRIASIS

HERPES

CANCER

COLD SORES/FEVER BILSTERS

N/a

First & Last Name

Your Signature

Select a date