*Please note that waxing does have certain risks and side effects such as skin removal, redness, bruise, scabs, swelling, tenderness, etc.

By signing this form, I am confirming that I have read and understand the above mentioned statement. I understand the procedure and accept the risks. I do not hold the esthetician and/or Hollywood Waxing Studio responsible for any conditions that may occur.


    Date of Birth


    Have you been waxed before?

    Have you used any Alpha Hydroxy Acid or Glycolic products?

    Are you using Retin-a, Renova, or Accutane?

    Are you using any other skin thinning products?

    Electronic Signature

    First Name

    Last Name