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Waxing Consultation Form -Form Fill
Q1
First Name
Name
Q2
Last Name
Name
Q3
Date of birth
Q4
Gender
Male
Female
Q5
Email
Q6
Phone Number
Q7
Have you had waxing treatments previously?
Yes
No
Q8
Did you suffer any adverse reaction?
Yes
No
Q9
Are you taking any medications?
Yes
No
Q10
If you have checked any of the below problems, then waxing treatment may be restricted or refused and you may be asked to contact your Doctor for advice.
Allergies
Diabetes
High/low blood pressure
Varicose veins
Heart condition
Haemophilia
Epilepsy
Heart condition
Radiotherapy
Q11
What waxing services would you like?
Eyebrow
Underarm
Chest
Full leg
Half leg
Chin
Back
Q12
Any Additional Requests
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