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    Wax Waiver Form: Importante Note

    Uploaded by

    Nailandia Main Square Bacoor
    The document is a waxing waiver form for a client of Nailandia Nail Studio and Body Spa. It asks the client questions about their medical history and any conditions that could be affected by waxing. These include questions about allergies, medications, skin conditions, and recent medical procedures. The client must sign to confirm they have provided accurate information and release the spa from any claims resulting from failure to disclose relevant details.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Wax Waiver Form: Importante Note

    Uploaded by

    Nailandia Main Square Bacoor
    135 views2 pages
    The document is a waxing waiver form for a client of Nailandia Nail Studio and Body Spa. It asks the client questions about their medical history and any conditions that could be affected by waxing. These include questions about allergies, medications, skin conditions, and recent medical procedures. The client must sign to confirm they have provided accurate information and release the spa from any claims resulting from failure to disclose relevant details.

    Original Title

    Wax Waiver Form

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    © © All Rights Reserved

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    The document is a waxing waiver form for a client of Nailandia Nail Studio and Body Spa. It asks the client questions about their medical history and any conditions that could be affected by waxing. These include questions about allergies, medications, skin conditions, and recent medical procedures. The client must sign to confirm they have provided accurate information and release the spa from any claims resulting from failure to disclose relevant details.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    135 views2 pages

    Wax Waiver Form: Importante Note

    Uploaded by

    Nailandia Main Square Bacoor
    The document is a waxing waiver form for a client of Nailandia Nail Studio and Body Spa. It asks the client questions about their medical history and any conditions that could be affected by waxing. These include questions about allergies, medications, skin conditions, and recent medical procedures. The client must sign to confirm they have provided accurate information and release the spa from any claims resulting from failure to disclose relevant details.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Wax Waiver Form

    Name: ____________________________________________ Date: __________________

    1. Have you ever had a professional waxing? YES: _____ NO: _____
    2. Have you ever had an adverse reaction to waxing? YES: _____ NO: _____
    If YES, please explain: ______________________________________________________
    ________________________________________________________________________.
    3. Have you been undergoing skin peeling? YES: _____ NO: _____
    4. Are you currently affected by any of the following condition?

    Phlebitis _____ Diabetes _____ Sunburn _____ Allergies ____Rash _____

    Herpes _____ Recent Peels _____ Menstrual Cycle _____ Distended Capillaries _____

    Hypertension _____ Recent Surgery _____ Varicose Vein _____ Recent Scar Tissue _____

    5. Do you have any medical condition, health problems, or other physical conditions that might affect
    you waxing service today? YES: _____ NO: _____
    If YES, please explain: ________________________________________________________
    _____________________________________________________________________________.

    6. Are you currently taking any medications? YES: _____ NO: _____
    If YES, please explain: __________________________________________________________
    ____________________________________________________________________________.
    Accutane _____ Retinol _____ Tetracycline _____ Renova ______
    Defferin Gel _____ Retin A _____ Any retinoid medication _____

    7. Have you recently take any blood thinner? i.e. Aspirin, Alcohol, Tylenol, Medication
    YES: _____ NO: _____
    If YES, please list: _____________________________________________________________

    IMPORTANTE NOTE:

    It is my choice to receive waxing. I understand that the information given above is strictly confidential and
    will be used for no other purpose than to assist NAILANDIA Nail Studio & Body Spa in customizing my
    waxing experience. I also understand that failure on my part to disclose information could result in injury
    and/or illness and I hereby release NAILANDIA Nail Studio & Body Spa from any claims resulting from
    such. Any information provide to me by NAILANDIA Nail Studio & Body Spa is for general educational
    purposes only and is not intended for any medical or therapeutic purpose.

    My signature below also indicates that I have stated any medications that I am taking. In addition, I
    understand that is my responsibility to update NAILANDIA Nail Studio & Body Spa if any of the
    above information has changed.

    Nailandia Nail Studio and Body Spa


    Main Square Mall Branch
    Client Signature: _________________________________________ Date: ____________________

    Nailandia Nail Studio and Body Spa


    Main Square Mall Branch

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