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CLIENT WAXING RELEASE
Name ___________________________________________________________________________________________________________________________________ Date___________________________________________________________________ m bikini m brazilian m legs m arms m chest m back m brows m lip m chin m face m under arms Have you had any adverse reactions to waxing, such as burning or allergic reaction? _______Y _______N If yes, please explain:______________________________________________________________________________________________________________________________________________________________________________________ Do you have any allergies, such as salicylic acid or adhesives? _______Y _______N If yes, please explain:______________________________________________________________________________________________________________________________________________________________________________________ Please indicate whether you are taking any of the following medications or using topical lotions that contain any of the following m Antibiotics m Retin-A or Retinol m Accutane m Coumadin m Glycolic Acid m Alpha/Beta Hydroxy Acids Individuals taking Accutane are NOT suitable for waxing on any part of the body. Accutane users must wait at least 6 months AFTER DISCONTINUING Accutane products before eligible for waxing. Other medications can increase skin sensitivity and could result in skin removal on waxed areas. No products are 100% hypoallergenic.
It is your responsibility to educate your esthetician if you are using any products containing the above mentioned ingredients before Waxing should not be done over varicose veins. Pregnant women are more sensitive and increased redness/swelling or skin removal may occur due to increased water retention and hormonal changes that affect the skin. Tanning, swimming and hot pool use is not advised for 24-48 hours after waxing. Individuals allergic to adhesives may react unfavorably to waxing. Waxing may cause reactions such as swelling and redness. This is normal for waxing, especially for the first time.
I am 18 years of age or older (bikini or brazilian waxing) ______________ By signing below, I realize even with the greatest care, lifting of the skin, tearing or bruising can occur due to no fault of my esthetician. I also understand that pimples, breakouts and ingrown hairs can result from the waxing process. I understand that wax from any procedure may stain my clothes. I have thoroughly read and clearly understand the previous information. If I have any questions regarding the waxing process, products used or any general questions, I will ask my esthetician.
Signature ________________________________________________________________________________________________________________________________________________ Date _______________________________________________ Parent Signature (if under 18) _________________________________________________________________________________________________________________ Date _______________________________________________

Source: http://thursdays-spa.com/wp-content/uploads/2012/09/waxing_release1.pdf

Pii: s0030-4387(00)00016-8

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