General Intake & Waxing Consent

  • MM slash DD slash YYYY
  • Best email to notify you of appointment information as well VIP news and info.
  • Such as skin lifting, burns, sensitivity, rashes, irritation or breaking out?
  • If yes please list, if no please indicate no.
  • Don't forget to list any topical medications, hormonal medications or birth control.
  • If yes please list procedure and date.
  • How did you hear about us? Is there anyone we should thank for your referral?
  • If yes, this form must be signed in the below section for parent's or legal guardians.
  • 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.
  • Please list a phone number you can be reached at if the service provider needs to contact you.
  • 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.