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Waxing Services
Name
*
First
Last
Email
*
Phone
*
Date of Birth
*
Are you wearing contacts?
*
Yes
No
Are you pregnant?
yes
no
How many weeks?
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For Waxing Services
Have you had any of the following symptoms within the last 72 hours?
Fever/Chills
Shortness of Breath/Difficulty Breathing
Congestion or Runny Nose
Dry Cough
Sore Throat
Loss of Taste or Smell
Fatigue
Nausea
Rash: Open Wounds; Warts (Hands/Feet)
I will keep my face covered for the duration of the service and in indoor areas open to the general public whenever six feet of separation cannot be maintained. Please initial:
*
I have not used a scrub, Retin A, Retinal OTC, take-home microdermabrasion, glycolic peel, peels, exfoliated or tanned in the last 72 hours. Please initial:
*
In the last 7 days, I have not had any Botox, Fillers, microdermabrasion, or chemical peels. Please initial:
*
I have been off Accutane for at least 8-12 months. Please initial:
*
Are you sunburned or windburned?
*
yes
no
For Bikini, French, and Brazilian waxing: I am not currently in my menstrual cycle. Please initial:
*
Please Note: For your safety, we are unable to accommodate these services during your menstrual cycle.
I do not have any open skin lesions, or active herpes outbreak (cold sore or genital). Please initial:
*
Please Note: For the safety of both you and your technician, we are unable to accommodate waxing services during an outbreak.
Are you diabetic or do you have circulatory problems?
*
yes
no
Are you currently on a blood thinning medication?
*
yes
no
Some possible side effects of waxing include redness, swelling and pimples, but are temporary and will generally fade within 72 hours. Please initial:
I agree to adhere to safety post care including: no peels, exfoliation, tanning, steam rooms, hot tubs. and/or pools for at least 48 hours. Please initial:
*
I am at least 18 years of age or I have parental consent signed below. Please initial:
*
I certify that the above information is complete and correct. I will keep the therapist informed of any changes as they occur. I will be responsible For making payments on any appointment which is not cancelled 24 hours in advance. I understand that Breckenridge Grand Vacations, Refresh Massage Studio, and any therapist working at this business will not be liable for any injuries or loss sustained to myself or property at this location, and that the procedures I am receiving are not intended to be a substitute for professional medical treatment For any condition.
Consent
I agree to the policy
Waxing Services Payment
I authorize Refresh Massage Studio to charge the amount of my service to the credit card on file.
*
Yes
No
I understand that if I do not provide the appropriate cancellation window which is 24 hours in advance of my service my card will be charged for the full cost of service.
*
I agree to the policy.
I would like to include a gratuity for my service provider:
25%
20%
18%
Other
Tip Amount
*
Δ
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