Tailored Waxing Services | Beauty Barn Turvey, Bedford

First name:*

Surname:*

Contact Number:*

Address:*

Postcode:*

Doctor's Name:*

Surgery Name and Address:*

How often do you have waxing done?

Have you ever had a reaction to a waxing service?*

If yes, please describe:

Do you have any tendencies to:

Ingrown Hairs*

Scarring*

Bumps*

Hyperpigmentation*

Bruising*

Are you allergic to anything?*

If yes, please state

Have you received Botox treatments in the lasts 72 hours?*

Have you been or will you be in the sun and/or tanning bed within 24hrs of this treatment?*

Are you using or taking:

Accutane or Tetracycline?*

Retinolds such as Retin-A, Renova AHA/Alpha-Hydroxy Acid?*

Glycolic Acid?*

Any other medication?*

If yes please state:

Are you currently pregnant?*

Do you have diabetes, Phlebitis or any skin irritations?*

Is your skin dry?*

I have been advised the service(s) provided to me by Beauty Barn could have unfavourable results including but not limited to: allergic reaction, irritation, burning, redness, soreness, etc. I am aware that certain medications and over the counter products can significantly increase the risk of injury when combined with skin care services. I Understand that the Beauty Barn does not recommend skin care services for customers using Retin-A, Accutane and products contacting alpha hydroxyl, or any other skin thinning treatments. I hereby confirm that I am not using any medications that may cause or contribute to such injury/reaction and I advise my therapist should I use any such medications in the future. I understand there are often inherent risks associated with skin care services and I agree that as a condition of producing these services on an ongoing basis, I will not hold the Beauty Barn liable.*

Yes

I allow the website to collect and store the data I submit through this form*

I agree that my information can be kept and that it will be held strictly confidentially under the Data Protection Act as required by my insurance and law.*

Yes

Signed:

Date:*

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Beauty Barn Turvey

Waxing Form

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