Name
*
First Name
Last Name
What are your pronouns?
*
She/Her
He/Him
They/Them
Prefer not to say
Email Address
*
City & Zip-code
*
Phone
*
(###)
###
####
Date of Birth
*
MM
DD
YYYY
What do you value the most? A: Stability, Structure, Planning, Rules. B: Freedom, Flexibility, Excitement. C: Relationships, Teamwork, Community. D: Learning, Logic, Research, Accuracy.
List below any known skin allergies and skin sensitivities to products or ingredients.
*
Any cold sores breakouts today or recently? (Herpes Simplex I)
*Please know, any face waxing services or facial treatments will NOT be performed on anyone with a current cold sore breakout until your breakout is completely healed and gone*
Yes
No
I never get cold sores
I recently had one but it's completely healed
Are you Pregnant?
Yes
No
Not yet, I'm trying
Acne problems?
Yes
No
List any Antibiotics you currently taking, any prescriptions for Acne you currently using (topical acne creams, oral or antibiotics). Any advanced Anti-aging skin lines you currently use or Retin-A prescriptions. Please write the name of the brand, prescription and the strength of the medication. *If None, please type None*.
*
Are you under a dermatologist's or a doctor’s care?
Yes
No
If yes, explain:
Do you currently use any of the following medications or products with any of the following ingredients?
Accutane
Retin-A
Glycolic Acid
Lactic Acid
Salicylic Acid
Hydroquinone
Differin
Isotretinoin
Renova
Tetracycline
Avage
Tazorac
Vitamin A
Topical Cortisone
If yes, how long and how often do you use these products? Please list the medical name and strength. If you took any of these in the past, when was the last treatment? Use this space to explain:
Please note, do not expose skin to the sun or tanning beds for at least 48 hours after any waxing service or advanced facial treatments. Please use SPF products, 30 minutes before sun exposure to prevent discoloration.
*
I understand all the above and I assume full responsibility thereof.
Any past skin reactions after a waxing service or a facial treatment?
*
Yes
No
If yes, please explain:
What type of services are you looking for?
*
Have you been waxed before? Any skin concerns?
*
Are you taking blood thinners? Do you take an aspirin daily or often? Please use the space below to explain further. If NO, please type no.
*
Please check any that apply to you:
*
Latex Allergy
Aspirin allergy
Epilepsy
Immune Disorders
Diabetes
High Blood Pressure
Contact lenses
Eczema
Herpes Simplex I
Skin Cancer
Warts
HPV
Pacemaker
Asthma
Lupus
Heart Condition
Hepatitis
Psoriasis
Thyroid
Taking Blood Thinners
Vitiligo
Cancer
Tuberculosis
Metal plates or pins
Hormone imbalance
Hysterectomy
Seborrheic Dermatitis
Hepatitis A or C
Taking Aspirin Daily or Often
Recently took Blood Thinners
Low Blood Pressure
Other
None
*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?
*In the past week, have you had a fever, any respiratory or flu symptoms, a sore throat, or shortness of breath?
*Are you currently feeling 100% healthy, without any cold, flu, or congestion symptoms?
If any of the these questions apply to you, please use the box below to further explain.
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.
Please don't bring anyone with you during your appointment. Other people or kids are NOT allowed in the room.
Symptoms of being sick and COVID-19 include: Fever, Chills/Shakes, Difficulty Breathing, Dry Cough, Sore Throat, Sneezing, Body aches, Skin Rashes, Sudden loss of taste or smell.
**Please know if you come in sick you'll be asked to reschedule & your booking deposit will be forfeited- unless you notify me ahead of time**.
Spa Policies
*
36-Hour Notice Policy:
We kindly request that you notify us at least 36 hours in advance if you need to reschedule, cancel, or modify your appointment for any reason. You can reach us via call, text, or email. We strive to respect your time and schedule and appreciate the same in return. Please note that we have a 5-minute grace period for late arrivals to avoid affecting our schedule.
Appointments Policies:
A deposit is required to book an appointment with us. If you need to cancel or modify your appointment with less than 24 hours’ notice (for any reason or excuse), a fee of 30% of the total booked services will be required on the same day before you can schedule your next appointment. Payment can be made via Venmo or credit card. This policy also applies to clients with prepaid series.
In the event of a missed appointment without prior notice or late arrival (more than 10 minutes), the full 40% booking deposit will be forfeited, and a full prepayment will be required for all future appointments.
Discounts or promotional offers associated with late cancellations will not be transferable or honored for future bookings.
Prepaid Wax Series Policy:
Waxing series require pre-booked appointments with no more than 6 weeks of each other. If hair is overly long due to extended time between visits, an additional 20-25% fee will be required to cover extra time and product used.
The promotional value of the series expires after 3 months of inactivity. Upon expiration, completed services are recalculated at regular rates, with any remaining balance refunded from the original prepaid amount. We do not provide full refunds for prepaid series.
We truly appreciate your support and understanding in following our small business policies. Thank you for being a valued client!
I have read, I understand and I agree with these Spa Policies for this visit and for all future visits.
*PLEASE TYPE YOUR FULL NAME BELOW*