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Waxing Forms

Name:

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Address:

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City:

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State

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Zip:

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Home/Cell phone:

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Work Phone:

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Email Address:

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Have you used any Alpha Hydroxy Acid (AHA) or glycolic products in the past 48-72 hours?

Yes

Are you using Retin-a, Renova or Accutane (an oral form of Retin-a)?

Yes

Are you using any other skin thinning products and/or drugs?

Yes

Are you exposed to the sun on a daily basis or are you considering spending more time in the sun soon?

Yes

Do you use a tanning bed?

Yes

Are you diabetic?

Yes

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Age

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