Waxing Service Questionnaire

Please complete this intake form carefully and honestly before receiving waxing services.

Client Info

First name

Last name

Email address

Phone number

Date of birth

Month

Day

Year

Appointment Information

Date of Appointment

Time Of Appointment

Time

Medical & Skin History

Please disclose any relevant medical conditions or skin sensitivities to help us provide you with the safest service possible.

Please list any allergies or additional medical conditions we should be aware of

Have you had a waxing service before?

Yes

Are you currently pregnant?

Yes

Anything else you would like your Waxing Specialist to know?

Client signature

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Date

By Checking this box, I confirm that all information I provided in this form is accurate and complete to the best of my knowledge, and agree to notify the service provider prior to my appointment if any of the information I have provided changes. I understand that this information will be relied upon by the service provider to determine my suitability for waxing services and to help ensure my safety during treatment.