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Birthday
Month
Day
Year
How did you hear about Elegant N Royalty Skin?

Please give a full description of the service you will be getting. For example: Full Brazilian, Brazilian + Basic vajacial .. etc

Have you ever experienced an allergic or severe reaction to waxing, skincare products, cosmetics, or hair-removal products?
Yes
No
Do you currently have any open cuts, wounds, sores, burns, sunburns, rash, infection, or significant irritation in the treatment area?
Yes
No
Do you currently have an active skin condition affecting the treatment area?
Yes
No
Have you experience significant skin lifting, tearing, bruising, or another adverse reaction from waxing in the past?
Yes
No
Are you currently experiencing unexplained itching, swelling, pain, discharge, or other unusual symptoms in the treatment area?
Yes
No
Have you recently had surgery, a medical procedure, laser treatment, IPL, microneedling, chemical peels, or another professional treatment involving the area being serviced?
Yes
No
Are you currently pregnant or recently postpartum?
Yes
No
Prefer to discuss privately
Do you have any known allergies?
Yes
No

If yes, please explain:

Are you currently taking any medications or using topical products that may affect your skin's sensitivity, healing or reaction to treatment?
Yes
No

If yes, please explain:

Please check any products you currently use on or near the treatment area:
Retinoids/retinol
Prescription topical medications
Exfoliating acids/AHAs
BHAs/salicyclic acid
Benzoyl peroxide
Hydroquinone
Other brightening products
Exfoliating scrubs
Chemical peels
Other

When was the last time you used these products on the treatment area?

Before waxing, please disclose whether any of the following apply:
Recent sunburn
Recent tanning
Recent spray tan
Recent shaving
Recent waxing
Recent chemical exfoliation
Recent laser/IPL
Recent peel
Recent use of retinoids/retinol
Broken or irritated skin
Recent intimate treatment
None of the above

Date of your last wax/shave, if applicable:

Latex Allergy:
Yes
No
Unsure
I understand that waxing and skincare services may produce temporary or, in some circumstances, more significant skin reactions. Possible reactions may include, but are not limited to temporary redness, folliculitis, minor bleeding, or skin lifting.
Yes
No
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