Body Waxing

PERSONAL INFORMATION

Name
Date
Date of birth
Age
Address
City
State
Zip
Phone
Email
Emergency contact
Phone
How did you hear about us?
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H E A L T H H I S T O R Y

Please check any of the following conditions that applies to you:
Any other conditions:
Do you have any medication allergies?
Are you currently taking any medication (including vitamins and supplements)? List it here:
Any surgeries in the last six months?
Are you pregnant or breastfeeding?

T R E A T M E N T P E R F O R M E D :

FACE & BROWS
UPPER BODY
LOWER BODY
OTHER

S K I N I N F O R M A T I O N

Please list any skin care products that you currently use:

Have you used any AHA products in the last 72 hours?
Are you using Retin-A, Renova, or Accutane?
Are you using any other skin thinning products and/or drugs?
Are you exposed to the sun on a daily basis?
Do you currently have a sunburn?
Do you plan on spending more time in the sun soon?
Have you recently used a tanning bed?
Have you recently had a chemical or glycolic peel?
Have you waxed before?
If yes, did you have any adverse reactions?
If yes, please explain:
Do you have any abrasions, moles, or skin irritations in the areas being waxed today?
If yes, please explain:
(Female clients) When is your next menstrual cycle due to begin?

*For your own comfort, we recommend avoiding hair removal from two days before to two days after your cycle.

B E YOND BEAUTY MEDICAL AESTHETICs
WWW.BEYONDBEAUTYACADEMY.ORG