Smooth Skin Company

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

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Phone Number *

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I am over the age of 18 or have parental consent co-signed below. *

Agree

Disagree

I give consent to the Esthetician at Smooth Skin Company *

Agree

Disagree

I have not used a scrub, Retin-A, Retinol OTC, taken home micro-adermabrasion, glycolic peels or other peels, exfoliated or tanned in the last 72 hours. *

Agree

Disagree

I have been off of Accutane for at least 12 months. *

Agree

Disagree

I understand that some possible side effects of waxing include redness, swelling and pimples but that these are temporary and generally fade within 72 hours. *

Agree

Disagree

For a Brazilian and/or bikini waxing, I will notify my Esthetician if I am on my menstrual cycle. *

Agree

Disagree

I do not have any open skin lesions or an active herpes outbreak (cold sore or genital). *

Agree

Disagree

I understand that with treatment, certain risks are involved and that any complications or side effects from known or unknowns causes could occur and freely assume these risks. *

Agree

Disagree

I agree to adhere to all safety post-care including the following: no peels, tanning or wet room services; no swimming, spas, or hot tubs for 72 hours after waxing; and choose to follow any at-home protocols as instructed by my Esthetician. *

Agree

Disagree

My signature acknowledges that I have read the above statements and agree to receive treatments or series of treatments from Smooth Skin Company and that I will adhere to all of the aforementioned statements that I have initialed. *

Agree

Disagree

Today's Date *

MM

DD

YYYY

Client Signature *

First Name

Last Name

Guardian Signature

If applicable

First Name

Last Name

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 if needed. *

I understand