Release of Liability Waiver: Waxing Services

Release of Liability for Waxing Services

1. Are you currently using Renova? *
2. Are you currently using Retin-A? *
3. Are you currently using Differin? *
4. Have you used Accutane anytime within the last six weeks? *
5. Are you diabetic? *
6. Do you have Fibromyalgia? *
7. Do you have any form of herpes? *
8. Do you have any staph infection? *
9. Do you have any skin conditions or allergies? *
10. Are you currently taking any medications or antihistamines? *
I confirm to the best of my knowledge, that the answers I have given are correct and that I have not withheld any information that my be relevant to my treatment. I agree to hold Spa Escape, and its employees harmless for any and all side effects, which may result from my informed decision to receive waxing services. I have read and understand the above release of liability waiver and hereby give my consent to receive waxing services.