Waxing Client Consultation Form Please fill out this form before your first appointment. Your answers will better help us to meet your needs and ensure that you have a happy and satisfying experience.Name* First Last Appointment Date* MM slash DD slash YYYY Appointment Time* : Hours Minutes AM PM AM/PM Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your Phone*Your Email* Date of Birth* MM slash DD slash YYYY Emergency Contact Phone Waxing Required TodayFace and Brows Brow Shape Lip Chin Full Face Sideburns Brow & Lip Neck Upper Body Full Arms Half Arms Underarms Back / Shoulder Abdomen Chest Lower Body Full Legs Half Legs Other Treatments Brazilian - Full Bikini Brazilian - Shape Full Body Treatment QuestionsHave you used any Alpha Hydroxy Acid (AHA) or glycolic products in the past 48-72 hours?* Yes No Are you using any other skin thinning products and/or drugs that thin the blood?* Yes No Have you been exposed to any tanning method in the past 24 hours?* Yes No Are you using (or have you ever used) Retin-A, Renova or Accutane?* Yes No Do you use a tanning bed or tan in the sun on a regular basis?* Yes No Have you had waxing treatments previously?* Warm wax Hot wax Sugar wax Sugaring None of the Above Did you suffer any adverse reaction? If yes, please give some details:Are you currently affected by any of the following conditions?* Recent Surgery Phlebitis Diabetes Sunburn Recent Peels Herpes Recent Cuts/bruises/burns Rash Distended capillaries Cold/flu/fever Inflammation No/None of the above Are you allergic to anything?* Yes No If yes, please give some details Are you currently under the care of a physician?* Yes No If yes, please give some details Are you currently taking any medications?* Yes No If yes, please give some details Do you have any skin sensitivities or skin irritations?* Yes No If so, please list: (i.e Dry skin, rash or any other sensitivities) (Female clients) When is your next menstrual cycle due to begin?(Always allow five days for menstrual cycle. Because of water retention and for your own personal comfort, you should avoid hair removal two days before your cycle is due and two days after it is completed.) MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged. Δ