Wax Questionnaire

Home
Services
- Facial
- Massage
- Body Treatment
- Waxing
- Make Up
Booking
Policies
Contact Us

Home
Services
- Facial
- Massage
- Body Treatment
- Waxing
- Make Up
Booking
Policies
Contact Us

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

(415) 721-2996

Today's Date

Your Birthday

Full Name

City

County

ZIP Code

Telephone

What body part are we waxing today?

When did you last shave?

How often do you shave?

Do you have any tendencies to:

Ingrown Hair?

Yes No

Hyperpigmentation

Yes No

Scarring

Yes No

Bruising

Yes No

Are you currently using or taking:

Accutane?

Yes No

Resorcinol?

Yes No

Retin-A?

Yes No

Glycolic Acid?

Yes No

Alpha-hydroxy Acid?

Yes No

Scrub or Peel of any kind?

Yes No

Medical Data::

Herpes Virus?

Yes No

Allergies?

Yes No

MRSA

Yes No

Others

Herpes Or MRSA Aceptance

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

Physical Symptoms Acceptance

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.).

All reactions Acceptance

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.

All terms and Conditions

I accept the Terms and Conditions.

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