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Client Consent Form

WAXING AND TWEEZING

Type of Service

CONSENT AND RELEASE AGREEMENT FOR

WAXING AND TWEEZING

We recommend that no client, under any circumstances, receive a waxing or tweezing service if any form of the following scenarios applies:

 

• Pre- or post-exposure to the sun, within 24 hours of receiving the service.

• Use of Renova, AHA, Differin, Retin A, acid-based products, or any other retinoid or retinol related products.

• Under a doctor’s care for any skin-related condition or illness.

• History of: reactions to tweezing or waxing, allergies (please inform us of all).

• Diabetes, flat moles, phlebitis, and fragile capillaries-any of these can cause increased sensitivity to waxing and tweezing.

• Increased sensitivity may occur during pre-menstruation or while taking antibiotics.

• Skin conditions such as broken skin, inflammation, active herpes or suspicious growths.

• Use of Accutane or any products related to Accutane.

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We recommend that you refrain from any of the following after receiving waxing or tweezing services:

• Sun exposure at least 24 hours after waxing or tweezing.

• Saunas, steam rooms, and other heat sources.

• Application of Retin A, Renova, AHA products at least 48 hours after waxing and tweezing.

• Abrasive products on any areas waxed or tweezed.

• For Bikini waxing, no exercise, intercourse or tanning for at least a day.​

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We would like to inform you of the following:

Individual sensitivities may occur during tweezing and/or waxing services, regardless of a client’s history of sensitivity.

 

Please inform your technician if you have experienced any of the following: sensitivities to scented cosmetic formulations, tea tree oil, or any other form of topical treatment.

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PLEASE NOTIFY YOUR TECHNICIAN BELOW OF ANY QUESTIONS OR CONCERNS REGARDING YOUR PROCEDURE OR IF ANY OF THE ABOVE SCENARIOS APPLY TO YOU OR ANY MEDICAL CONDITIONS.

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Client medical History

Please let the technician know if any of the following apply to you: 

  • Diabetes 

  • Pregnancy

  • Nursing

  • Lupus

  • Hepatitis (A,B,C,D)

  • AIDS

  • Active Skin Disorders: Cold Sores, Shingles, Impetigo, Psoriasis, Pink Eye, Sun Burn, Severe Acne, New Scar Tissue

  • Epilepsy

  • Herpes

  • Active Vitiligo

  • Severe Rosacea

  • Blood Disorders: Sickle Cell, Hemophilia

  • Keloid Formation

  • Mental Disorder

  • Accutane (must be 0_ for 6 months)

  • Steroids (must be 0_ for 6 months)

  • Retinol/Retin-A (stop using 7 days prior)

  • Poor Circulation

Do the medical list above apply to you in any way?**

If yes, name your condition.

Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl alcohol, Carbopol, Lecithin, Propylene glycol, Vitamin E Acetate, ect.**

Allergies to metals, food, latex, antibiotics.**

Do you have menstral period?** 

If yes, when?

Currently on any blood-thinning prescription drugs.**

If yes, when?

Special requests, concerns or remarks for technician:

Photo Permission

I grant permission to TN-Beauty, Thunyatorn LLC, Thai Serenity Spa to take and use: photographs and/or digital images of me for use in news releases, educational materials and/or social media platforms including but not limited to Instagram, Facebook, and Pinterest. If no photo please inform your your artist.**

STATEMENT OF CONSENT AND RECITALS:
  PLEASE READ AND CHECK ALL LINES

  • I acknowledge I am age 18 or older.

  • I understand that after my service, there will be no refunds. No exceptions.

  • I acknowledge it is not reasonably possible for my technician to determine whether I might have an ALLERGIC reaction to the coconut oil, healing oil, aloe vera, baby powder, or any waxing products used in this process. I agree to forego a patch test and accept the risk that such reaction is possible and I already informed technician all the allergics and medical conditions I have. 

  • The staff at TN-Beauty, Thai Serenity Spa and Thunyatorn, do not practice medicine, does not accept health insurance, and have made no representation to the contrary.

  • The information provided on this form is accurate and complete to the best of my knowledge, and that TN-Beauty, Thai Serenity Spa and Thunyatorn are not responsible for complications or problems arising from any incorrect or omitted information. I will contact my doctor immediately, if I experience abnormal pain, discomfort, infection due to lack of proper after-care or health related issue.

  • Some individuals will have complications related to waxing procedures. These complications are usually mild and last only a few days. However, extreme complications are always a possibility. I accept these risks and agree to hold Thunyatorn and its employees and contractors harmless for same.

  • I have read all the Precare guidelines and acknowledge that Aftercare instructions are available on www.TN-Beauty.com. I agree to follow them to the best of my ability. I agree that any follow up work needed, due to my negligence will be done at my own expense.

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I certify that I have read or have had read to me the contents of this whole form. I understand the risks and alternatives involved in this procedure(s) and I have had the opportunity to ask questions and all of my questions have been answered. 

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By signing below, I acknowledge, understand and agree with all the items on this form.** 

Consent to Treat a Minor:

By my signature below, I hereby authorize technician to administer services to my child or dependents. 

**Please fill out all required fields

Please let us know if you would you like to receive a copy of this statement and consent.

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