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*Do any of the following pertain to you?

Currently taking medication(s) prescribed by a Dermatologist especially for acne or wrinkle prevention
Accuta ne/ Differ in/Tazorac/Glycolic Acid/ Retin A/ Renova or ary prescribed medication for acne or anti-aging
Clarasonic Brush/ Facial Exfoliating Scrubs/ Facial Peels Obagi
Currently or recently ill
Antibiotics/ Antiviral/ Aspirin/ Ibuprofen medications
Autoimmune Disease/ Diabetes/ HIV/ Hepatitis/ Lupus
Allergies/ Allergic reactions
Birth Control/ Hormones
Botox/ Juvederm/ Restylene) other filler injections
Bruise Easily/ Unhealed Cuts
Herpes/ Cold Sores/ Fever Blisters
Irregular Pigmented Moles/ Warts/ Growths
Keloids/ Pigmented Scars
Pregnant/ Breast Feeding
Previous Laser Procedures/ Chemical Peels/ Dermabrasion/ Microdermabrasion
Recent Surgery/ Medical Procedures
Recent Travel
Sunburn/ Tanning/ Indoor Tanning
Under the care of a physician that would affect or interfere with the followings service(s)


  • Tweezing and waxing may cause sensitivities, even in clients with no prior history of any known sensitivities
  • We are not able to provide service if you have broken skin, inflammation, suspicious growths, active herpes, using any AHA or BHA/ acid-based type products, or have a history of prior reactions to waxing.
  • If you are prone to Herpes/ Cold Sores/ Fever Blisters, you may need a prescription for Acyclovir/ Zovirax from your physician prior to havinq treatment. Always avoid exfoliating treatments during a breakout.
  • You may be more sensitive to the procedure if you are pre-menstrual or pregnant.
  • Anytime the skin is broken, there is a slight risk of bacterial and/ or viral infection.
  • You must keep treated area clean and dry. Moisturize and protect the newly exposed/ exfoliated skin with adequate sunscreen/ SPF 1 5 or higher, as you are more susceptible to sunburn and skin damaqe
  • Avoid the use of any AHA or BHA/ acid-based type products for 2-4 days following service.
  • It is recommended that following the waxinq procedure, you:
    • Avoid sun exposure for at least 24-48 hours after service
    • Avoid Jacuzzi, saunas, steam rooms, or other heat sources
    • Avoid using any kind of exfoilating, AHA or BHA/acid-based type products
    • Consult with the Esthetician if you are using such products and discuss the appropriate length of time for discontinued use of products after service.

*By signing below, I acknowledge that I have read and understand the foregoing informed consent and agree to the service with associated risks. I hereby agree to have tweezing and/ or waxing services performed and agree to follow all of the pre and post treatment instructions. I release and hold Lash & Brow Envy, its employees and its representatives harmless from z and all claims/ damages associated with this procedure.

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(If client is under 18 years of age)

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