Wax Questionnaire.


Your skin is most beautiful when it’s healthy. We believe that by focusing on nourishment, restoration, and damage prevention, outward radiance naturally follows. Skin health doesn’t need to be complicated.

Working hours

From 9:00 AM to 4:00 PM 

Location 

1000 5th Ave. Suite 4
San Rafael, CA 94901

Phone 
Wax Questionnaire

 

Do you have any tendencies to:

Yes No
Yes No
Yes No
Yes No
Yes No

Are you currently using or taking:

Yes No
Yes No
Yes No
Yes No
Yes No
Yes No

Medical Data:

Yes No
Yes No
Yes No

If I have Herpes or MRSA I may experience an outbreak. My professional has explained the reasons and understand (please check).

I understand I may carry Herpes and/or MRSA without any physical symptoms or having had a medical diagnosis confirmed (please check).

Waxing may cause:

Bruises, scabs, scarring, redness, hyperpigmentation or pimples. Waxing of soft tissue may cause the skin to tear resulting in the need for stitches. (Most common occurrence is in Brazilian Bikini waxes, male or female.)

I understand all of the above mentioned reactions I also understand if I change my skin care routine or medications.
I must inform the professional PRIOR to starting any service in the future..

I accept the Terms and Conditions.