Waxing Intake Form + Liability Waiver

Full Name *

Date of birth *

Email *

Phone *

How Did You Hear About Us? *

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

Yes

If yes, please describe:

Do you use Glycolic Acid, Salicylic Acid, Lactic Acid or any other acid- based products on your face or body? *

Yes

Have you had recent microdermabrasion, laser resurfacing or injectable fillers? *

Yes

Are you taking acne medication or vitamin-A products? *

Yes

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

Yes

I agree to terms & conditions provided by XO Brow. By signing below, I understand that topical creams, medical conditions, and certain medications can affect the results of waxing. I understand that I can not be waxed if I have certain contraindications and I hereby release XO Brow harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act, or misinformation both intentional or accidentally on this form as well as failure to follow post-care instructions after my service.

Signature *

Clear

Date *