Surveypoint

Q1

Client

First Name

Q2

Client

Last Name

Q3

Phone Number

Q4

Email

Q5

By checking the following boxes, confirm that you willingly consent to the following terms and conditions:

I give permission to my therapist to perform the waxing procedure we have discussed and will hold her and her staff harmless from any liability that may result from this treatment.

I recognize that the results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require further treatments of the treated areas to obtain the expected results at an additional cost.

If I have any concerns, I will address these with my skin therapist.

I have read and understand the post-treatment home care instructions and understand how important it is to follow all instructions given to me for post-treatment care.

Q6

By checking the following boxes, confirm that you willingly consent to having the treatment during the COVID-19 pandemic:

I am aware of the risks of having hair services during the pandemic.

I understand that physical distancing of 6 feet may not be possible while in the salon receiving services.

I will follow the rules in order to minimize the spread of viruses. I understand that I must sanitize my hands before entering the salon and I must wear a mask that covers my mouth and nose while in common areas.

I confirm that I have not travelled domestically or internationally via public transportation within 14 days.

I do not have any of the following COVID-19 symptoms: cough, shortness of breath, high fever, muscle pain, body ache, nausea, loss of taste, loss of smell.

I have not contacted with anyone that have or may have COVID-19 symptoms or get infected within past 14 days.

Q7

Date

Q8

Waxing Consent -Form Fill

Client

Client

Phone Number

Email

By checking the following boxes, confirm that you willingly consent to the following terms and conditions:

By checking the following boxes, confirm that you willingly consent to having the treatment during the COVID-19 pandemic:

Date

Client Signature