Waxing Consent Form

Birthday

Are You Currently Under A Dermatologist's Care? If Yes Please Explain

Are You Currently Taking Any Topical Prescription Medications Prescribed or Over The Counter? (If Yes Please List)

Are You Currently Taking or Have You Ever Used Accutane? If Yes When?

Have You Been In The Sun Or Tanning Beds In The Last 24 hours?

Are You Currently Going Through Chemotherapy Or Radiation?

Are You Currently Receiving any type of exfoliation or peeling treatments?

Please Check If You Are Using Or Taking Any Of The Following:

Please Check If You Have Any Of The Following Illnesses?