Waxing intake form

Are you over 18 years old?* required

Yes

No

Are you allergic to Latex?* required

Yes

No

Are you using any of the following?* required

Retin-A

Renova

Accutane (oral form of Retin-A)

None of the above

Using any skin thinning products/medications?* required

Yes

No

Are you taking any antibiotics? * required

Yes

No

Are you exposed to the sun daily?* required

Yes (more than 1 hour a day)

No

Any adverse reactions to previous brow tinting?* required

Yes

No

Are you diabetic?

Yes

No

Are you currently pregnant ?* required

Yes

No

Have you ever been treated for cancer?

Yes

No

Have you use a tanning bed in the last 72 hours?

Yes

No

Had any of the following in the last week?

Chemical peel

Botox

Laser treatment

None of the above