Please fill out this Waxing Consent Form prior to your first visit:

Name: *

Email: *

Date of birth: *

Address:

City:

State:

Zip Code:

What part of the body are we waxing?

How often do you shave?

Are you currently being treated with chemotherapy? *

Are you being treated for diabetes? *

Have you recently received a chemical peel? *

Have you been medically diagnosticated with Herpes Virus? *

Are you exposed to sun on a daily basis? *

Do you work near an UV source? *

Are you regularly taking any medication, being treated by a Dermatologist or Plastic Surgeon for any condition or surgery? *

Have you ever used Retin A, Acutane or Renova products in the past 6 months or are you currently using any of them? *

I agree and understand that I may experience possible redness in some parts of my body after waxing and in case of a Brazilian Bikini Wax, I may experience some skin irritation due to the nature of the skin in the area. It is with this understanding that I agree to have these services and I accept all responsibility for such thereby releasing the BMB and the service provider (Technical Professional) from liability.
I agree.