Wax Intake form | L Egance Esthetics

Treatment areas

lip

eye brows

back

arm

legs

Brazilian

Other services during this session

Brow lamination

Lash Lift

First name*

Last name*

Phone*

Email*

Address*

Allergies*

Have you ever had a waxing treatment? How long ago? and describe. if does not apply put N/A*

I confirm that I am at least 18 years old

I confirm that I am not under the influence of alcohol or recreational drugs

I confirm that I do not have any open lesions or outbreak of contagious skin lesions

I agree to follow the aftercare instructions provided by the Esthetician to minimize the risk of complactions and ensure optimal results.

I understand that after the waxing procedure, temporary side effects such as redness, irritation or discomfort may occur.

Please list any medications you’re currently taking that can cause thinning of the skin, or cause excess bleeding such as Aspirin, steroids, etc. (If does not apply put N/A)*

Are you taking retinol topical or taking any tyle of oral type of retinol /vitamin A for your skin such as Accutane or Renova? If so, when was the last time you used it? (If does not apply, put N/A)*

Have you every had a reaction to a waxing service in the past? If yes, explain.*

Have you had recent Microderm abrasion, laser resurfacing, injectables?*

yes

If answered "yes" above, would this effect the treated area during this service? yes or no or n/a*

Do you use Glycolic Acid, Salicylic Acid, Lactic acid, BHA, Nair removal products or any other acid based products on your face or body?*

yes

If answered "yes" above, would this effect the treated area during this service? yes or no or n/a*

I confirm that its been 2 days since I completed by menstrual cycle.

For brow lamination and or tint when was the last time you waxed the brow area? If not applicable put n/a*

I understand the following aftercare instructions:

Avoid excessive direct sun exposure for 72 hours

Additional instructions: I understand no tanning/tanning bed for 72 hours. Wear SPF 30+ with broad specturm coverage on waxed areas that will be exposed to the sun. Side effects may include but are not limited to dryness, peeling, redness, tingling, swelling, tenderness and changes in skin color/shade. Avoid using any acid-based products or chemical treatments for atleast 72 hours. Avoid excessive sweating during the next 48 hours.

I understand to avoid saunas and hot tubs during the next 48 hours following my wax treatment.

I acknowledge that I have read and fully understand the terms of this release and that I have had the opportunity to ask any questions that I may have before signing.

I grant permission to L Egance Esthetics to take photographs or videos of me, my likeness and my overall appearance during my visit/appointment. (optional)

By signing below, I hereby release L Egance Esthetics Wellness and Beauty harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses, and compensation.*

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