Client form - Wax Haus and Skin

Email Address

City & Zip-code

What do you value the most? A: Stability, Structure, Planning, Rules. B: Freedom, Flexibility, Excitement. C: Relationships, Teamwork, Community. D: Learning, Logic, Research, Accuracy.

How did you hear about Wax Haus and Skin?

Referred by:

List below any known skin allergies and skin sensitivities to products or ingredients.

If none, please type "N/A"

If yes:

Where?

Are you currently taking blood thinners or regularly taking aspirin? If yes, please provide details below. If no, please type "No".

Please note: These medications can make the skin more fragile, increasing the risk of lifting, bruising, and damage. They are contraindicated for waxing and certain facial treatments. Please contact me for a consultation before booking.

Please list any prescribed medications (from a doctor) you are currently using, including: Antibiotics (oral or topical), Acne treatments (topical creams, oral medications, or antibiotics), Anti-aging prescriptions (Retin-A, tretinoin, or other medical-grade treatments). Include the brand name, prescription name, and strength of the medication.

If none, please type "None"

If yes, explain:

If yes, how long have you been using these products, and how often do you apply them? Please provide the medical name and strength. If you have used any of these in the past, when was your last treatment? Use the space below to provide details:

(Only if they are prescribed medications, not OTC products)

If yes, please explain:

Have you been waxed before? If so, how was your experience? Have you ever experienced any skin reactions after a waxing service? If so, please describe.

What type of waxing services are you interested in? Do you have any skin concerns or current issues with ingrown hairs?

*Please use this space below to write any additional information for any of the questions listed here*

Common Cold & Flu Policies

*Have you recently experienced any cold symptoms or felt unwell, even if it was just a common cold? *Please know if you come in sick or congested you'll be asked to reschedule. Since COVID-19, we have increased our sanitation and disinfecting practices and we are taking extra precautions before and after each client. We will review your health history and ask health questions before we can see you at our facility.

Spa Policies

We kindly request that you notify us at least 48 hours in advance if you need to reschedule, cancel, or modify your appointment for any reason, in order to avoid any booking fees. This policy also applies to clients with prepaid series. You can reach us via call, text, or email. Please arrive on time: A 5-minute grace period is allowed; late arrivals beyond this may disrupt our schedule, and you might need to reschedule. Prepaid Waxing Series Policies: Waxing series require pre-booked appointments with no more than 4 weeks of each other. Thank you for respecting our spa policies, which allow us to serve you with excellence. I have read, I understand and I agree with these Spa Policies. *PLEASE TYPE YOUR NAME BELOW*

Wax Haus and Skin Policies/Liability/Disclosures:

• We can't wax anyone who’s on Accutane, Retin-A or other prescriptions that exfoliate or thins the skin • We cannot perform any services on clients with a current cold sore breakout, open wound or sores • You understand that a wax or a skin service can trigger a cold sore outbreak • Prices are subject to change without notice (services and products) • No cash refunds for gift certificates • DISCLOSURE: I understand all spa and waxing services involve touching and close physical proximity over an extended period of time, and that there is an elevated risk of disease transmission, including COVID-19. I (the client submitting this form) understand that withholding information or providing misinformation may result in contraindications and/or irritations to the skin from treatments received. I release D. Perivolaris and Wax Haus and Skin from liability and assume full responsibility thereof. I fully understand all that is listed in this form, and I authorize treatments from my Esthetician at Wax Haus and Skin. *Information in this form is completely private and confidential*. By submitting this form, your email will be added to our private email list for our spa updates, promotions, newsletters and reminders. We do not share or use your email for any other reason. If you don't want to receive emails from us, you can unsubscribe instantly from our list with the link provided there. *PLEASE TYPE YOUR FULL NAME BELOW*

Please Submit Online.