Facial Wax Consent Form Name : * First Name Last Name Guardian's Name : (in case when the client is a minor) First Name Last Name Phone : * (###) ### #### Email : I hereby, agree to have a facial waxing procedure performed on my face. By signing this agreement, I consent to the facial waxing procedure by a Brows on Fleek technician. I understand that on rare occasions there are risks associated with having facial waxing such as skin removal, redness, swelling, tenderness, and so on. I agree that if I experience any of these conditions with my skin that I will contact the technician that performed this procedure and that it may be beneficial to contact a physician without delay, at my own expense. I understand and agree to the after-care instructions provided by the technician. I realize and accept the consequences of failure to adhere to these instructions may cause injury to the skin and/or scarring. After care instructions include: No Peels, No Tanning and No wet room services for at least 72 hours or 1 week. I am informing the certified technician of the following conditions by marking with a check, agreeing to have the procedure be performed on me despite any risk: Check all that apply: Sunburned and/or very tanned skin Menstruation Pregnancy Use of Accutane over the last one year Any recent use of Retin-A, Tretinoin, Renova, any type of acne medicine History of Diabetes Any facial surgical procedures Any open skin lesions and/or active herpes outbreak Any recent scrubbing and/or exfoliation or tanning of the skin Any known allergies (please specify): Any medical and/or skin condition which would prohibit or compromise the procedure of facial waxing (please specify) This agreement will remain in effect for this procedure and all future follow-ups conducted by the certified technician, and will hold the technician/s harmless from any liability that may result from this procedure. I read English and understand that this consent agreement is legal and binding. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above agreement clauses, and that I have had sufficient opportunity for discussion to have all my questions answered. I understand the procedure and accept the risks. I do not hold the technician responsible for any of my conditions that were present, but not disclosed at the time of this procedure that may be affected by the treatment performed today. I further agree that I will not hold Brows on Fleek or its affiliates or any of its employees responsible should there be any unfavorable outcome or result. Date : * MM DD YYYY Thank you!
