Wax Consent Form Step 1 of 7 14% Name(Required) First Last Date of Brith(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920If You Complete the From on Behalf(Required) First Last Relation To Client(Required)Contact Number (Mobile)(Required)Contact Number (Land Line)Email Address & Postal Code(Required) FirstLine Second Line City Post Code Occupation(Required)Do You Have WhatsApp?(Required) Yes No Best Way to Contact You?(Required) Call SMS WhatsApp Email Select All Please read and complete this form carefully.Please indicate your answer by checking one box per question and provide detail where appropriate.To the client: You have the right to be informed about the procedure(s) to be administered, including benefits, risks, and potential side-effects, so that you can decide whether to proceed. You are encouraged to ask any questions you may have and to consult with a therapist if you have additional questions.1.Do you have any medical and skin conditions?(Required) Yes No Please select from the following conditions(Required) Diabetes Epilepsy or episodes of fainting/fits Oedema or other swelling in the treatment area Nervous/psychotic condition Neuralgia Hypersensitive skin Phlebitis Receiving cancer treatment Psoriasis, rosacea, eczema Skin diseases or skin cancer Hyperkeratosis Sunburn, hives or prickly heat Undiagnosed lumps & bumps New scar tissue (under 3 months) in the treatment area Thin or fragile skin Irritated, inflamed or tender skin Skin disorders or infections Brusing, cuts or abrasions Hemorrhoids, moles, skin tags or warts in treatment area Microdermabrasion, IPL, laser treatment, electrolysis last 1 month in the treatment area Skin peels, use of AHA/BHA skin care in the treatment area Piercings or tattoos in the treatment area Ingrown hairs trichotillomania Hormonal implants Varicose veins Poor circulation Pregnancy Hemophilia Vascular disorder/ any medication relating to this Varicose/ excessive surface veins Joint / mobility problems Injury or broken bones Contagious or infectious diseases Urine infection if you have bikini wax Eye infection if you have eyebrows wax Styes if you have eyebrows wax Blepharitis if you have eyebrows wax Conjunctivitis if you have eyebrows wax Watery eyes if you have eyebrows wax Sinusitis if you have eyebrows wax Migraine / headache Undiagnosed pain Botox or dermal fillers Recent operations affecting the wax area Allergies or intolerance, including allergies to wax or latex Under influence of recreational drugs or alcohol Hepatitis, herpes, HIV or other sexually transmitted diseases Explain(Required)2.Have you used a tanning bed or experienced prolonged sun exposure within the past 24 hours?(Required) Yes No Explain(Required)3.Are you menstruating or about to begin menstruating?(Required) Yes No Explain(Required)4.Currently taking, or in the last 6 months have you taken, any prescribed Medication, undergone any medical/ cosmetic treatment or surgery?(Required) Yes No Explain(Required)5.Currently taking, or in the last 6 months have you taken, Roaccutane, Retin-A, glycolic acid, AHA skincare or any other acne medication?(Required) Yes No Explain(Required)6.Use of steroid creams or medication in the last 3 months?(Required) Yes No Explain(Required)7.Any other Prescribed medicine?(Required) Yes No Explain(Required)8.Have you had a waxing treatment before?(Required) Yes No Explain(Required)9.Any other thing you want to disclose about yourself?(Required) Yes No Explain(Required)10.Do you have any conditions that could affect your immune system e.g. Hepatitis C Virus (HBC), Hepatitis B Virus (HBC), AIDS, HIV infection?(Required) Yes No Explain(Required) Refrain from: Touching the treated area Using soaps, cleansers, creams or make-up on the treated area for 5 days Facial treatments - including eyelash or eyebrow tinting or tweezing, electrolysis. waxing etc. Any abrasive products, rough towels or similar DO NOT TOUCH or PICK the small scabs that may appear after the treatment. Healing will take up to one week, and it is perfectly normal for the treated area to scab/flake. These scabs/flakes will fall off within a few days. Taking hot baths, saunas, or any other heat treatments. The treated area should be kept as dry as possible. Sunbathing, using sun beds or swimming Using any form of bleach or depilatory products Should an infection occur, seek medical attention Expose the treated area to UV rays Use make-up other than the recommended after care products Going for any Laser or IPL treatments Procedure:Waxing is a procedure to remove unwanted hair from its roots. Wax is applied to the skin and then quickly pulled away, taking hair with it.Side Effects: The side effects listed here are merely examples and are not intended to be an exhaustive list. Every person is different, and there is no guarantee that you will not experience more severe side effects. The most common side effects include quickly dissipating, mild discomfort when the wax removes hair from its root. Waxing may cause inflammation, welts, hives, skin lifting, and reddening or small breakouts. This is usually not severe and typically will subside within a few days.Please contact us immediately if you experience more severe or long-lasting side effects. Avoidance: Accutane (wax after 12 months) Antibiotics (wax after 2 to 3 weeks) Cortisone creams – steroid (after 3 months) Retin-A / Renova tretinoin (wax after 7 days) AHAs / BHAs / Glycolic / Acids / chemical peels (wax after 7 days) Laser treatments (wax after 3 to 4 weeks) Microdermabrasion (wax after 2 to 3 weeks) Recent cosmetic surgery once healed and clear from GP Terms of Service(Required)I Understand that I am responsible for notifying the beauty therapist if any of the information should change before treatment. I confirm that the information is true to be best of my knowledge. I have been fully informed about the expected results and effects of my treatment and agree to follow all aftercare advise provided by therapist. I acknowledge that all information is confidential and will be held on file for 7 years, being solely for the purpose and use of my therapist. I hereby give my consent to proceed with treatment. I understand and agree that all services rendered are charged directly to me and I am personally responsible for payment. I further agree in the event of non-payment, to bear the cost of collection, and/or Court cost and reasonable legal fees, should this be required. By signing below, I acknowledge that I have read the foregoing informed consent and agree to the treatment with its associated risks. Under fake not to make a claim against the therapist and salon and do hereby indemnify and hold the said business, its Owner and Employees harmless in respect of any claim or damage suffered by me in the consequence of undergoing the treatments procedure. I agree to the Terms of Service Printed Name(Required) First Last Guardian Printed Name(Required) First Last October 9, 2026Unique IDClient Signature(Required)Guardian Signature(Required) Where did you hear about the clinic? Recommendation Advert Social media Other otherI would like to be notified of any upcoming offers or promotions: YES! I love it! No, Thank you CAPTCHA
