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Returning Client - Wax Intake Form

*Type of Service

Brazillian wax

Leg wax

Lip wax

Brow wax

underarm wax

back wax

*Date picker

*First name

*Last name

*Any changes to your skin condition or regimen since the last visit?

*Any new allergies or sensitivities since your last visit?

I confirm that I am not on chemotherapy or taking radiation treatment.

*Please list any medications that you are currently taking that can cause sensitivity, thinning of the skin or cause excess bleeding such as Aspirin, steroids, antibiotics

I confirm that I do not use glycolic acid, salicylic acid, BHA, Nair removal products or other acid based products on the treatment areas or, it has been atleast 7 days since I last used it.

I confirm that I do not have any open lesions or outbreak of contabious skin lesions

I confirm that I am not under the influence of alcohol or recreational drugs.

I confirm that I did not have any recent microderm abrasion, laser resurfacing or injectables within the treatment area.

I confirm that I am not on topical / oral vitamin A products, or it have it has been atleast 1-2 weeks since I applied topical retinol, or any type of vitamin A products, or taken oral Accutane/Renova.

I understand the following aftercare instructions: Avoid excessive direct sun exposure for 72 hours, OR tanning/tanning bed for 72 hours. Wear SPF 30+ with bread spectrum coverage on waxed areas that will be exposed to the sun.

*For Brazillian wax

I understand to avoid heat, sweat, friction, or sexual activity for atleast 24-48 hours, and wear loose clothing.

N/A

*For Brazilian services :

I confirm that its been 2 days since I completed by menstrual cycle

N/A

*Other aftercare instructions:

I understand to apply moisturizer, cold compress to reduce redness and inflammation, avoid touching waxed area, or profuse sweating, swimming, and harsh chemical treatments to waxed area.

*By signing below, I hereby release L Egance Esthetics Beauty and Wellness LLC harmless from and waive on behalf of myself my heirs and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation

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LET'S GET IN TOUCH

Location

379 Kamehameha Hwy

Beauty Room 2 (second floor

inside Beauty & the Brow)

Pearl City Hawaii, Hawaii

leganceesthetics9.com

email: leganceesthetics9@gmail.com

Instagram: readysetglow_9

Phone: 8087210957

Opening Hours

Mon-Sunday

by appointment only

Available online

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1 hr 20 min • $150

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