Release of Liability Waiver: Waxing Services

Release of Liability for Waxing Services

Overview

Waxing is a safe technique done for the removal of unwanted hair. Most clients suffer no adverse side effects whatsoever. However, side effects can include but are not limited to; mild redness, swelling, dry skin, bruising, abrasions, bumps and blisters above or beneath the skin surface, all of which are temporary. Exposure to the sun immediately after waxing service is discouraged. Please inform waxing technician of any skin condition, allergy, or other medical condition prior to waxing. Your information is kept strictly confidential.

Name

First

Last

1. Are you currently using Renova? *

Yes

No

2. Are you currently using Retin-A? *

Yes

No

3. Are you currently using Differin? *

Yes

No

4. Have you used Accutane anytime within the last six weeks? *

Yes

No

5. Are you diabetic? *

Yes

No

6. Do you have Fibromyalgia? *

Yes

No

7. Do you have any form of herpes? *

Yes

No

8. Do you have any staph infection? *

Yes

No

9. Do you have any skin conditions or allergies?

Yes, please specify:Yes, please specify:

No

10. Are you currently taking any medications or antihistamines? *

Yes, please specify:Yes, please specify:

No

Signature

Clear

I confirm to the best of my knowledge, that the answers I have given are correct and that I have not withheld any information that my be relevant to my treatment. I agree to hold Spa Escape, and its employees harmless for any and all side effects, which may result from my informed decision to receive waxing services. I have read and understand the above release of liability waiver and hereby give my consent to receive waxing services.