I have not used a scrub, Retin-A, Retinol OTC, take home micro-dermabrasion, glycolic peels, other peels, exfoliated or tanned in the last 72 hours.*

I have been off of Accutane for at least twelve (12) months.

Some possible side effects include redness, swelling and pimples, but these are temporary and generally fade within 72 hours.

I understand that with treatment certain risks are involved and that any complications or side effects from known or unknown causes could occur. I freely assume these risks.*

I agree to adhere to all safety post care including: no peels, tanning or wet room services; no swimming/spas/ hot tubs for 72 hours after waxing; and all home skin care protocols as recommended by my service provider. If I don’t follow these protocols I’m aware the provider is not liable for issues after.*

I understand that my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.*

I will call to inform my service provider of any complications or concerns I may have as soon as they occur.*

If at anytime things change I will let the service staff know before getting wax services.*

I give permission to my esthetician to perform the waxing procedure we have discussed and will not hold the esthetician nor the salon accountable for any liability that may result from this treatment.*

I have read the above information and have given an accurate account of the questions. If I have any concerns, I will address these with my esthetician before the service.*