Business owners regard electronic waxing waivers as their assistant.

Welcome to WAXON® Appleby.

For the safety of all our Clients we ask that you fill out this form.

Please note you do not need to fill out this waiver if you have already completed the New Client Form at another location.

Please fill in your name: *

Please enter your full name.

Date of birth: *

Please enter valid date.

We will not perform services on anyone under the age of 10, even with parental consent.

Are you 16 years or older? *

Yes

No

Please select at least one choice above.

Clients under the age of 16 MUST be accompanied by a legal guardian when attending their first appointment at WAXON. Please provide full name of parent / legal guardian.

Name of parent / legal guardian: Please enter your name.

Parent or legal guardian: Are there any services that are not approved? Please enter your answer here.

Signature of parent / legal guardian:

Click to sign

Please sign here.

Gender: * Please select one here.

Phone number: * Please enter your phone number.

Email: Please enter your email.

Postal Code: Please enter your answer here.

How would you like to be reminded of your appointments? *

Text Message

Email

Please select at least one choice above.

How did you hear about us? *

Friend / Family

Media / News

Social Media

Website / Google

Walking by

Please select at least one choice above.

If you answered Friend / Family, please provide their name. (If you refer 3 friends you get $50 on your account!) Please enter your answer here.

Have you used glycolic / salicylic acid or Retin A in the last 6 weeks? *

Yes

No

Not sure

Please select at least one choice above.

Have you taken Accutane? *

Yes, within the last 6 months

Yes, more than 6 months ago

No

Please select at least one choice above.

Are you using any face creams or washes for acne or anti-aging? *

Yes

No

Not Sure

Please select at least one choice above.

Have you had laser hair removal within the past 2 weeks? *

Yes

No

Please select at least one choice above.

If YES, which area of the body / face Please enter your answer here.

Have you gotten a tattoo in the last 6 weeks? *

Yes

No

Please select at least one choice above.

If YES, which area of the body / face? Please enter your answer here.

Have you had dermabrasion or a chemical peel in the past week? *

Yes

No

Please select at least one choice above.

Have you had any cosmetic injections in the past week? *

Yes

No

Please select at least one choice above.

Are you taking any blood thinning medications? *

Yes

No

Please select at least one choice above.

Do you have diabetes? *

Yes

No

Please select at least one choice above.

Have you been in the sun or tanning booth within the last week? *

Yes

No

Please select at least one choice above.

If you have any allergies, please list here: Please enter your answer here.

Anything else you would like us to know before your first WAXON appointment? Please enter your answer here.

The use of certain medications and tanning can hinder the result of your services including extreme redness, scarring, and lifted skin. Please consult your Waxologist if you have ANY questions or concerns about your service(s).

I authorize the Estheticians at WAXON Waxbar (“Waxologists”) to perform services(s) on me today and in the future. I understand that during or after waxing services, I may experience irritation or adverse reactions including, without limitation, redness or scarring of the skin, which may be caused or worsened by pre-existing medical conditions and/or medical treatments I am undergoing. I agree to notify WAXON Waxbar of any such medical conditions or treatments prior to receiving waxing service(s). I acknowledge that Waxologists are not healthcare practitioners and cannot, and do not claim to, diagnose or give advice on any medical condition(s) of the skin or otherwise. I agree to seek immediate medical attention and advice from a qualified medical practitioner should any irritation or adverse reaction, occur as a result of service(s). I hereby release, remise and forever discharge WAXON Waxbar and its owners, employees, successors and assigns, of and from any and all claims, liabilities, demands, actions and causes of actions relating to any loss, damage or injury that may be sustained by me or property belonging to me, whether caused by negligence or otherwise, while receiving service(s) or while on the WAXON Waxbar premises. The release shall bind my heirs, executors, administrators, agents, successors and assigns and shall apply to any service(s) I receive at WAXON Waxbar today and in the future.

By signing below, I certify that I have read and fully understand the above paragraphs and that I have had sufficient opportunity for discussion and to have any questions answered in connection therewith. *

Click to sign

Please sign here.

Please enter todays date *

Please enter valid date.