Consent Form

Client's Name

Email Address

Date of Birth

Address

Postcode

Contact Number

GP Practice

GP Contact Number

Have you had waxing done before? Yes No

Have you ever taken a reaction after a waxing service? Yes No

Do you have any allergy?

Are you prone to any of the following?
Ingrown Hairs
Bruising
Bumps
Hyperpigmentation
Scarring
Sunburn

Are you using or taking any of the following? If YES, please click the button below:
Accutane
Retinoids such as Retin-A, Renova or Differin
Alpha-Hydroxy Acid / Beta-Hydroxy Acid / Glycolic Acid
Tetracycline

Any other medication:

Are you currently pregnant? Yes No

Have you had microdermabrasion/dermaplaning in the last 2 weeks? Yes No

Have you had a chemical peel in the last 7 days? Yes No

Do you have Diabetes, Phlebitis or Any Skin Conditions? Yes No

Have you received any botox treatments in the last 72 hours? Yes No

Have you been on a tanning bed/sun in the last 48 hours? Yes No