Waxing Client Consultation Form
Full Name
Date of Birth
Phone Number
Email Address
Emergency Contact (Name & Phone)
Areas to be Waxed
Are you currently taking any medications (topical or oral)? If yes, please list.
Medical History
Do you have any of the following conditions?
Diabetes
Pregnant
Skin Sensitivities/Allergies
Using Acne Treatment
None
Do you use any skin care products? If yes, please list.
Have you been waxed before?
Yes
No
Have you ever had an adverse reaction to waxing?
Yes
No
List any allergies (including to wax, latex, etc.):
Additional Information or Concerns
Client Signature
Date