Waxing Consent Form

HAVE YOU TAKEN ACCUTANE WITH THE PAST YEAR?
ARE YOU TAKING ANY MEDICATIONS THAT MAKE YOU PHOTOSENSITIVE?
ARE YOU CURRENTLY SUNBURN?
ARE YOU USING RETIN-A, DIFFERIN, OR RENOVA?
DO YOU FREQUENT TANNING BEDS?
ARE YOU DIABETIC?

DO YOU CURRENTLY HAVE OR HAVE YOU HAD ANY OF THE FOLLOWING MEDICAL CONDITIONS THAT COULD COMPROMISE YOUR SKIN AND/OR SERVICES BEING OFFERED?

PLEASE READ THE FOLLOWING WARNINGS

IF YOU ARE USING ANY OF THE FOLLOWING MEDICATIONS, YOU CAN NOT BE WAXED TODAY:

ACCUTANE

RENOVA

TRETINOIN

ADAPALENE

ALUSTRA

AVAGE

ISOTRETINOIN

AVITA

DIFFERIN

RETIN-A

TAZAROTENE

YOU MAY EXPERIENCE SKIN SENSITIVITY/THINNING, WHICH CAN RESULT IN SKIN LIFTING, FROM THE FOLLOWING:

SUNBURNED SKIN

PREGNANCY

MENSTRUATION

RETINOL

ANTIBIOTICS

CERTAIN MEDICAL CONDITIONS

OTHER MEDICATIONS NOT LISTED

CONSENT AND SIGNATURE:

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