Wax Questionaire for Auburn Skin and Nail Care, Auburn, Washington
Today’s Date _________________________ Birthday__________________________
Name___________________________________________________________________________________
Address_________________________________________________________________________________
City__________________________________________ State___________ Zip________________________
Best number to leave messages (__________) _________________________________________________
Work Phone (_______) ___________________ Email __________________________________________
How did you hear about us? ________________________________________________________________
What body part are we waxing today?_________________________________________________________
When did you last shave? ___________________________________________________________________
How often do you shave? ___________________________________________________________________
| Do you have any tendencies for: | |
| Ingrown hair _____yes _____no | Hyper pigmentation _____yes _____no |
| Scarring _____yes _____no | Bruising _____yes _____no |
| Bumps _____yes _____no | Allergies _____yes ______no |
| Herpes Virus _____yes _____no | If yes, what ________________________ |
| Are you currently using or taking: | |
| Accutane _____yes _____no | Resorcinol _____yes _____no |
| Retin-A _____yes _____no | Glycolic Acid _____yes _____no |
| Alpha-hydroxy Acid _____yes _____no | Scrub or Peel of any kind _____yes _____no |
| Any other medication?______________________________________________ | |
| Waxing may cause bruises, scabs,
scarring, redness, hyperpigmentation or pimples. Waxing of soft tissue may cause
the skin to tear resulting in the need for stitches. (Most common occurrence is
in Brazilian Bikini waxes, male or female.) New use of the products discussed
increases the possibility of a reaction, so if started the waxologist must be
informed before the next wax appointment starts. By signing below, I am certifying that I understand all of the above mentioned reactions and will hold Auburn Electrology, Skin & Nail Care harmless from damages. |
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______________________________________________________ Client Signature and Date |
______________________________________________________ Waxologist’s Signature and Date |
One last note about waxing:
We don’t tweeze at our salon. This takes some getting used to on your part, but
the reason for this is that it will make your waxing service longer lasting.
Perfect waxing means wax is applied and removed and all the hair comes off. Now
you have a smooth, stubble free area that remains hairless in-between
appointments. This only occurs if the hair is long enough to be pulled out by
the root. Tweezing interrupts this from happening.
So we ask that you be patient for about 1 month, don’t tweeze, shave or use a
depilatory cream, come in every 3 to 4 weeks like clockwork and you will love
your waxing even more then you do now!
Auburn Electrology, Skin & Nail Care - http://www.auburnskincare.com/