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

-ACCUTANE
-ADAPALENE
-ISOTRETINOIN
-RETIN-A
-RENOVA
-ALUSTRA
-AVITA
-TAZAROTENE
-TRETINOIN
-AVAGE
-DIFFERIN

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

-SUNBURNED SKIN
- RETINOL
-CERTAIN MEDICAL CONDITIONS
-PREGNANCY
-ANTIBIOTICS
-OTHER MEDICATIONS NOT LISTED
-MENSTRUATION
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محو التحديد
HAVE YOU TAKEN ACCUTANE WITH THE PAST YEAR?
ARE YOU USING RETIN-A, DIFFERIN, OR RENOVA?
ARE YOU TAKING ANY MEDICATIONS THAT MAKE YOU PHOTOSENSITIVE?
DO YOU FREQUENT TANNING BEDS?
ARE YOU CURRENTLY SUNBURN?
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:
I UNDERSTAND THAT IF I BEGIN USE, OR ARE CURRENTLY USING, ANY OF THE PRODUCTS LISTED IN THE ABOVE WARNING AND DO NOT INFORM THE ESTHETICIAN PRIOR TO CURRENT OR FUTURE TREATMENTS, I ACCEPT FULL RESPONSIBILITY FOR ANY ADVERSE REACTIONS. I UNDERSTAND THAT WAXING MAY CAUSE SOME REDNESS, BUMPS, SORENESS, AND/OR ITCHING.
إرسال
محو النموذج
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