If you are a new client, please complete the form below before your first visit. Thank you!

Your name

Street Address

City

State

Zip

Phone number

Your email address

Which body parts are we waxing today? (check all that apply)

BrowsLipChinNeckSideburnsArmsUnderarmsBack / ShouldersAbdomenChestLegsBrazilianBikiniButt Strip

Please select any of the following medical or skin conditions that may apply to you:

DiabeticSensitive SkinProne to skin inflammationVaricose veinsHairy molesBruise easily

If there are any other medical conditions that we should be made aware of please list them below:

If there are any allergies that we should be made aware of please list them below:

Are you currently using or recently used any of the following products? (select all that apply)

Self-tannerVitamin A CreamFacial exfoliantsSkin lightening productsRetinoid or Retin AAcne medicationsAnti-aging creams

Please select any of the following that may apply to you: (select all that apply)

Currently experiencing sunburn and/or heat rashTanned less than 48 hours ago

Please mention any previous issues you may have experienced with waxing that we should be made aware of:

I acknowledge that the information I have provided is correct