Waxing Name * First Name Last Name Email * Cell Phone * (###) ### #### Age * Have you used any Alpha Hydroxy Acids (AHA) or glycolic products in the past 48-72 hours? * Yes No Have you used Retin-A, Renova, or Accutane within the past year? If so, when? * Are you using any other skin thinning products and/or drugs that thin the blood? * Yes No Do you use tanning beds and/or exposed to the sun on a regular basis? * Yes No Are you currently taking any medications? If so, please list. * Have you been treated for cancer? If yes, when and what types of therapies were used? * Please list any illness/conditions which you are currently being treated for by a medical professional. * Do you have any open skin lesions on the face? * Yes No Do you have any allergies? If so, please list. * Please note that waxing can have certain side effects such as skin removal, redness, swelling, tenderness, etc. * I have read the above information and have given an accurate account of the questions and if I have any concerns, I will address these concerns with GLO Aesthetics. I give permission to GLO Aesthetics to perform the waxing procedure we have discussed and will hold her harmless from any liabilty that may result from this treatment. I agree to adhere to all safety post care including: no peels, tanning, or wet room services; no swimming/spas/hot tubs/ for 72 hours after waxing. I understand that GLO Aesthetics will take every precaution to minimize or eliminate negative reactions as much as possible. Signature * Please type name to sign. Signing this form means you have read the above information, answered honestly, and accept our terms and service(s) at GLO Aesthetics. Date * MM DD YYYY Thank you!
