Full Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have any allergies or allergic reaction? *

Yes

No

Have you been waxed before? *

Yes

No

Have you had brow tint before? *

Yes

No

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

Yes

No

Do you have any tendencies to? (Check all that apply): *

Ingrown hair

Scarring

Bumps

Hyperpigmentation

Bruising

NONE

Are you currently using or taking? (Check all that apply): *

Accutane or Tetracycline

Retinoids such as Retin-A, Renova or Differin

AHA/Alpha-Hydroxy Acid

BHA/Beta-Hydroxy Acid

Glycolic Acid

NONE

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

Yes

No

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

Yes

No

Are you currently pregnant? *

Yes

No

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

Yes

No

Is your skin dry? *

Yes

No

All boxes must be checked. By doing so, you have read, understood and agree to the terms. *

I authorize Dreamluxe LLC dba Dreamluxe Esthetics and all affiliated estheticians to provide me with waxing services.

I understand and agree to follow the waxing aftercare instructions given by my esthetician and know that I can find the waxing aftercare can also be found at dreamluxeesthetics.com/aftercare-waxing

I understand that the hair cycle grows at different rates and I will need touch up appointments usually recommended every 4 to 6 weeks to keep skin looking smooth.

I understand that there is no patch test given and some slight soreness, small bumps and redness are common and perfectly normal temporary reactions. These symptoms should subside over the next 24-48 hours.

I agree to contact my esthetician if I experience persistent redness or irritation, or if I have any questions.

I grant permission for Dreamluxe, LLC and my esthetician to use my before and after photos and videos for marketing purposes or to display. DO NOT check box if you opt-out of this permission.

By signing this client waiver and release agreement, I, the client named below certify that I knowingly and voluntarily release Dreamluxe, LLC and it's directors, officers, owners, employees, agents and representatives from any and all claims for damages for personal injury arising from the waxing, but not limited to claims for negligence and pre-existing conditions.

This agreement will remain in effect for for this procedure and all future procedures conducted by Dreamluxe, LLC dba Dreamluxe Esthetics and all affiliated estheticians for the entire duration of my time using the services at Dreamluxe Esthetics.

I represent that I am or over the age of 18 years. If under 18, parent must sign this form and will therefore grant consent.

I certify that I have read and fully understand this Client Consent Form. I further certify that I have completed the Client Waiver & Release Agreement accurately and completely to the best of my knowledge, and that I understand the potential complications and risks described. I hereby authorize Dreamluxe, LLC dba Dreamluxe Esthetics and all affiliated estheticians to provide me with waxing services, in accordance with the terms and conditions set.

I have not traveled within the last 2 weeks and am not experiencing any COVID-19 symptoms.

Today's Date *

MM

DD

YYYY