Waxing Consultation Form

Client Consultation Form

Name

Address

Mobile Number

Email Address

D.O.B

Confidential – please indicate whether any of the following apply to you:

Recurrent treatment from doctor or other healthcare practitioner
Current medication (prescribed, over the counter or supplements
Recent scar tissue, cuts, bruises or other abrasions to area being waxed
Skin disorders or infections (e.g. eczema, psoriasis, ringworm etc)
Sunburn or heat allergies
Hypersensitive or highly reactive skin
Use of Roaccutane or other acne products in the last 6 months
Current use of AHA or BHA products (e.g. glycolic or salicylic acid etc)
Use of steroid creams or steroid medication in the last 3 months
Varicose veins or capillary damage in the treatment area
Haemophillia
Heart Conditions
High/Low Blood Pressure
Diabetes
Oedema or other swelling in treatment area
Nerve damage or increased/decreased sensitivity to the skin
Epilepsy, fits or fainting attacks
Allergies or intolerances (e.g. to lanolin, sticking plasters, nuts etc)
Conditions or medical treatment causing immune- suppression
Pregnancy
Previous reactions to waxing

If you have ticked any of the above please provide further information below

I confirm I am happy to receive offers via email or text message in the future, your details WILL NOT be passed onto any other companies

Yes
No

I confirm that the above information is true to the best of my knowledge and belief. I have been fully informed about the expected results and the effects of waxing and agree to follow all aftercare advice provided by my therapist. I hereby give consent to proceed with treatment

Yes