Waxing Consent form Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone numberReferred by:Are you prone to experiencing?Ingrown HairsScarringBumpsHyperpigmentationBrusing Have you taken ACCUTANE in the past year?YESNOAre you using RETIN-A, DIFFERIN, OR RENOVA? YESNOAre you taking any medications that make you photosensitive? YESNOARE you using an ALPHA HYDROXY ACID OR BETA HYDROXY ACID? YESNOAre you diabetic? YESNOAre you currently pregnant? Are you allergic to anything?YESNOif yes, please describe:Any other medications?Do you agree to adhere to all safety post care including: no peels, tanning or wet room services; no swimming/spas/hot tubs for 72 hours after waxing; and all home skin care protocols as recommended by my aesthetician?YesNoDo you understand that with treatment certain risks are involved and that any complications or side effects from known or unknown causes could occur. I freely assume these risks? YesNoFor Brazilian and/or bikini waxing , do you agree to notify your aesthetician if you are on your menstrual cycle? YesNoDo you understand that some possible side effects include, redness, swelling and pimples, but these are temporary and generally fade within 72 hours. YesNoPhotographs relating to my case, may be published and/or republished, either separately or in connection with each other, in professional journals, medical books, social media, skin care magazines, slides, or used for any purpose which he/she may deem proper in the interest of medical education, knowledge, or research, provided, however; it is specifically understood that in any such publication or use I shall not be identified by name( unless given permission).AgreeDisagreeMy signature acknowledges that I have read and agree to receive the treatments or series of treatments listed above and that I will adhere to all of the warnings above. Date *PhoneSubmit