Wax Consent Form

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Wax Consent Form

See separate sections for tinting and lamination if applicable

Name *

Phone Number *

Email *

Address *

Date of Birth *

YYYY

How did you hear about us? *

Photography Consent

Before and after photos will be taken at every appointment for Outer Beauty's records. I give Outer Beauty Permanent Makeup permission to publish and reproduce photographs of me, both before and/or after the application for advertising.

Yes

Reschedule/Cancel Policy

We ask that you please reschedule or cancel at least 24 hours before the beginning of your appointment. A NON REFUNDABLE booking fee is due for each appointment. This fee go towards the total cost. The appointment can be rescheduled with the booking fee transferred once as long as it is more than 24 hours before the original appointment date. If rescheduled a second time, you will lose your booking fee and need a new one to reschedule. If you are more than 15 minutes late or no show, the booking fee will be forfeited and a new one will be required to reschedule. I have read and understand the reschedule/cancel and late policy.

Please type name stating you read and agree

I acknowledge that my skin might experience temporary irritation, tightness, redness or slight swelling which usually dissipates within 72 hours depending on skin sensitivity. I acknowledge that if I am allergic to one or more ingredients in the products used, I may experience allergic reactions. I acknowledge that if I fail to use a minimal sunscreen (SPF45), I am more susceptible to sunburn, skin damage & hyperpigmentation. I should avoid excessive sun exposure especially between 10am-2pm. I acknowledge that this treatment is strictly elective cosmetic procedure and no medical claims have been expressed or implied. I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, waxing, and products containing acids that are not part of the recommended take-home regimen for 2-4 weeks following treatment. I agree (to the best of my knowledge) that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment. I give consent for all future treatments.

I WAIVE AND RELEASE to the fullest extent permitted by law Outer Beauty Permanent Makeup LLC, its employees, officers, and agents from all liability whatsoever, including but not limited to, any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the procedure and application of esthetic treatments, whether caused by the negligence or fault of Outer Beauty Permanent Makeup LLC, its employees, officers, or agents

Please enter today's date

YYYY

Any medical conditions

Hormone imbalance

High blood pressure

Heart problems

Auto-immune disorder

HIV/AIDS

Epilepsy/Seizures

Depression/Anxiety

Accutane in the last year

Eczema

Rosacea

Allergies/Hayfever

Cancer/Chemotherapy in the last year

Diabetes

Arthritis

Cold sores

Lupus

Alopecia

Psoriasis

Keloids

Pregnant/Nursing

On Birth Control

Other:

Any allergies?

Latex

Fragrance/Essential Oils

Tree Nuts

Lavender

Hair Dyes

Lidocaine

Jasmine

Metals

Other:

Any medications or supplements you're currently taking?

Last date of botox or filler in forehead?

YYYY

Are you currently using

Accutane

Vitamin A/ Retinol

Prescribed topical cream

AHAs (glycolic acid, lactic acid, mandelic acid, etc)

BHAs (salicylic acid)

Chemical Peels, laser peels, or microdermabrasion in the last month

Have you ever had a reaction to waxing? (Breakouts, lifting, etc)

Yes

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