Please read and sign the following information about contradictions and agreement.
Possible Complications with waxing/sugaring procedures:
All hair removal including waxing/sugaring certain areas can be uncomfortable. We attempt to minimize discomfort with a professional technique. In addition, there are also steps that can be taken before the procedure, such as taking ibuprofen or other oral analgesic before the procedure. Please tell us if there is anything we can do to make your waxing experience more comfortable.
Accutane and Retin-A or Tretinoin are drying to the skin, therefore, waxing may lead to removal of skin, which may cause scarring. Waxing over sunburned or very tanned skin may lead to removal of the skin, which may cause scarring. Do not use wax hair removers, perform dermabrasion, or laser skin treatments while you are taking Accutane and for at least 6 months after you stop taking it. Scarring may result.
Anyone showing signs of redness, rash, open and/or abraded skin, an active lesion of Herpes Simplex I or II, sunburn (either from natural sun exposure or a tanning bed), psoriasis or eczema cannot receive waxing/sugaring services.
Regarding Herpes Simplex Types I and II, anyone with a history of Herpes Simplex I or II has been advised that waxing/sugaring services may cause an outbreak to re-surface.
Diabetics have a very hard time healing when a wound or lesion occurs to the skin, as the immune system is unable to function fully to fighting bacteria.
Allergies to any of the product ingredients used in waxing may cause severe allergic reaction.
We have the right to refuse services for all waxing if proper hygiene is not followed.
For Brazilian and bikini waxes, please use the provided wipe to cleanse area. I will notify my esthetician if I am on my menstrual cycle.
I understand that sensitive skin can have side effects such as burning or skin removal from waxing/sugaring procedures. Some other possible side effects include redness, swelling, and pimples, but these are temporary and generally fade within 72 hours.
I do not have any open skin lesions or active herpes outbreak (cold sore or genital)
I confirm (to the best of my knowledge) that the information I have provided is accurate and complete. I have not withheld any information that may be relevant to my treatment and/or the results thereof. I am aware that there are often inherent risks associated with skin care services including waxing/sugaring procedures, and that the services I am about to receive could have unfavorable results including, but not limited to: allergic reaction, irritation, burning, redness, scarring, soreness, etc. By signing below, I further agree that I will not hold Refined Beauty Boutique, its owner, its affiliates or any of its employees responsible should there be any unfavorable outcome or result.
I have read the above information and if I have any concerns, I will address these with my skin therapist. I give permission to my esthetician to perform the waxing procedure we have discussed and will hold her and her staff harmless from any liability that may result from this treatment.
I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.
I have read and understand the post-treatment home care instructions. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product / post-treatment care, I will consult the esthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and
fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand that with treatment certain risks are involved and that any complications or side effects from known or unknown causes could occur. I understand the procedure and accept the risks. I do not hold the esthetician, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.
I agree to adhere to all safety post care including: no peels, tanning or wet room services; no swimming/spas/hot tubs for 72 hours after waxing; and all home skin care protocols as recommended by my service provider.
I am over 18 years of age or I have parental consent co-signed below.
For Parent: (Must be completed for clients under the age of 18)
In consideration of the client “Minor” (named below) being permitted by Refined Beauty Boutique to participate in its services including but not limited to, skin care services, including hair removal (sugaring/waxing). I further agree to indemnify and hold harmless Refined Beauty Boutique, its professional esthetician, and affiliates from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such services by Minor.
My signature acknowledges that I have read and agree to receive the treatments or series of treatments listed above and that I will adhere to all of the aforementioned statements that I have initialed.
