General Intake & Waxing Consent

Todays Date(Required)

First and Last Name(Required)

First Last

If you go by another name or nickname please let us know

Current Age(Required)

If you are a minor, the parental consent portion at the bottom of this page must be filled out by your parent or legal guardian.

Date of Birth(Required)

Email(Required)

Best email to notify you of appointment information as well VIP news and info.

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

How did you hear about us? Is there anyone we can thank for your referral?(Required)

Please be ask specific as possible so we know what's working! Ask about earning rewards for new client referrals.

Do you use SPF daily?(Required)

Yes

Are you allergic or sensitive to anything? If so please list.

Have you ever had any issues with waxing?(Required)

Such as skin lifting, burns, sensitivity, rashes, irritation or breaking out?

yes

If you answered yes, please describe what happened and indicate when this occurred.

Are you currently using any of the following products?(Required)

If you checked any of the items above please list those specific products you are using below.

Are you being treated for any medical conditions?(Required)

If yes please list, if no please indicate no.

Do you take any medications?(Required)

Don't forget to list any topical medications, hormonal medications or birth control.

Have you recently had any injections such as Botox Fillers, or any other facial treatments or surgeries?

If yes please list procedure and date.

If this is your first visit to Celebrity Skin Studio

How did you hear about us? Is there anyone we should thank for your referral?

Are you a Minor or under legal guardianship?(Required)

If yes, this form must be signed in the below section for parent's or legal guardians.

yes

Signature(Required)

Date(Required)

This final section applies to Parental/Legal Guardian Consent only

This section must be filled out if client is a minor or a ward under legal guardianship. Please fill out all fields.

For Parent or Legal Guardian, please list any necessary instructions.

Parent/Legal Guardians Printed Name

First Last

Phone

Please list a phone number you can be reached at if the service provider needs to contact you.

Parent or Legal Guardians Signature

By my digital signature I I give permission for her/him to receive services at Celebrity Skin Studio LLC. I confirm that I have read and understand all information on the applicable forms for this treatment or service, and accept responsibility on my child’s or ward's behalf for any disclosures or liability described on those forms. I agree to supervise any service bookings and home care procedures that are recommended as a result of the treatment.

Date