Waxing Disclaimer Form

Waxing Disclaimer Form

Caribbean Day Spa
Information

Clients sometimes experiences hives immediately after a waxing. They can be small itchy bumps right where hairs were or larger welts that look like mosquito bites. The hives only last a short time. An hour at most. Typically, hives on the area that was waxed first, are already fading by the time the waxing service is completed. This is a histamine reaction. The body is reacting to the hairs being pulled out. The body is perceiving the hair removal as a threat. The immune system springs into action producing histamine to fight the threat, like an allergic reaction. Does this mean my client was allergic to the wax? No. The body is reacting to the irritation of the hair being pulled out not the wax itself, producing inflammation and hives as a defense mechanism.
Name

First NameLast Name
Date of Birth

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Age
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Cell Phone

Area CodePhone Number
Occupation
Please check off any of the following that you are presently using:

Retin-AAccutaneGlycolic AcidRenova
Please check all that apply (Counter Indications):

AIDSHemophiliacOn Blood ThinnersDiabeticHerpetic BreakoutPre or Post ChemotherapyThin SkinSun or Wind BurnGrades 2, 3, or 4 AcneDeep WrinklesLess than one week since a chemical or micro peelOpen Wounds or Abrasions
RESCHEDULING GUIDELINES

Please indicate below that you agree to the following:
A 24-hour rescheduling notice is appreciated and required. We realize emergencies happen and will be understanding if a last minute change arises; however, we reserve the right to charge full treatment price for missed appointments without a 24 hour notice. When scheduling spa packages, a 50% deposit is required to reserve services and are non-refundable in the case of cancellation without prior notice.*

AgreeDisagree
I understand that I am responsible for any trauma or reactions, scabbing, redness or pimples that I experience from the service known as waxing. I also understand that if I start to use any of the products mentioned above and do not inform my technician, I am accepting responsibility for my skin reaction.
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