New Client Brazilian Wax Form

New Client Brazilian Wax Form

Professional Skin Waxing Salon
By submitting this online form you will save time during your first appointment. Your form will be printed out and waiting for you at the salon. Simply tell us you completed this form. Thank you
Full Name*

First NameLast Name
Age Group*

Younger the 1818 and older
I am sorry but we DO NOT perform Brazilian Waxing on customers under the age of 18. Thank you.

New Client - {fullName}
How did you here about us?

ReferralGoogle SearchOther Internet SearchDriving byFacebookInstagramOther Social MediaOther

New Client - {fullName}
Email*
Cell Phone*

Area CodePhone Number

New Client - {fullName}
PRIVACY NOTICE:
Your address below is for our internal records ONLY! We WILL NOT mail you any information.
Address (Optional)

Street Address

Street Address Line 2

CityState

Zip Code

New Client - {fullName}
We need to know just a few things so we can provide you with a safe and efficient wax.
Is this your first Brazilian Wax?*

YesNo
AWESOME! You are going to love not shaving!
Have you ever had a reaction to a waxing service?*

YesNoNot Sure
No problem. You can explain the reaction you had when you come to your appointment.
Will you be tanning prior to your wax appointment?*

YesNo
NOTE!
You may still get waxed but DO NOT tan within 3 days of your wax appointment

New Client - {fullName}
Are you taking any of the following medications?

Retin A or Retinal productsAlpha Hydroxy AcidAccutaneOther
WARNING!
The medication you selected can cause an adverse reaction to waxing. Once you are off your medication for 3 Months you can get waxed. Your safety is important to us.
Is there anything else you would like us to know prior to your wax?
- I understand that most services performed require me to remove my clothing. Although the therapist will do his/her best to maintain my privacy, there will be times I will be completely exposed to provide the required service.
- I understand that the services are performed by hand and I give the therapist my complete approval to provide the requested services.
- I understand that during my Brazilian wax, I will be waxed in my entire pubic and anal area including but not limited to the Labia, Clitoris, Vestibule & Urethra. I fully release the therapist from any legal actions that may arise from these services.
- If at any time you are uncomfortable with the service being performed you should inform the therapist and discontinue the service.
- I understand that there are often inherent risks associated with skin care services, and I agree that as a condition of providing these services on an ongoing basis, I will not hold this salon or any of its employees responsible should there be any unfavorable outcome or result.
- I have been advised that the service(s) provided to me by this salon although rare may have unfavorable results including, but not limited to: allergic reaction, irritation, burning, redness, soreness, etc.
- I am aware that certain medications and over-the-counter products can significantly increase the risk of injury when combined with waxing. Never use additional hair removal products such as but not limited to “Nair” after a waxing service for at least 4 weeks.
- I understand that this salon does not recommend waxing for customers using Retin-A, Accutane, products containing Alpha Hydroxy, or any other skin-thinning treatments. I hereby confirm that I am not using any medication that may cause or contribute to any such injury/reaction, and I will advise my therapist should I use any such medication in the future.
- Professional Skin DOES NOT perform Brazilian Wax services on people under the age of 18. If you are under 18 you MUST inform your therapist and you will receive a standard Bikini wax.
I have read the terms above and agree

I have read the terms above
Please verify that you are human*
Should be Empty: