215-340-3930

HOME
SHOP
NEW CLIENTS
ABOUT US
SPA
OUR SERVICES
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SPECIALS
CONTACT US
- Existing Client Appointment Request
CLIENT PORTAL

215-340-3930

HOME
SHOP
NEW CLIENTS
ABOUT US
SPA
OUR SERVICES
RESOURCES
SPECIALS
CONTACT US
- Existing Client Appointment Request
CLIENT PORTAL

New Waxing Client Form

New Client Appointment Checklist

5

Complete and submit form below

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Please arrive at least 15 minutes early for your first appointment.

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These guidelines are in place for your protection and ours, as we strive to serve you to the best of our ability.

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Please understand the importance of keeping your appointments. We do have a 48 hour new client/24 hour regular client appointment cancellation policy that is strictly enforced.

New Client Form

CLIENT INFORMATION:

Name: *

Today's Date: *

Home Phone Number:

Cell Phone Number: *

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Email: *

Birthdate:

In Case of Emergency, please contact:

Emergency Contact Name: *

Emergency Contact Phone Number: *

Relationship: *

How often do you have waxing done?

Have you ever had a reaction to a waxing service?

Are you allergic to anything?

Are you on any medications? *

Yes
No

If so, please list medications:

Have you been in or will you be in the sun (or tanning bed) within 24 hours of this treatment? *

Yes
No

Have you received any Derma-brasion treatments? *

Yes
No

Have you received Botox treatments in the last 72 hours? *

Yes
No

Are you using Retin-A, Accutane, Alpha Hydroxy, Tetracycline or any other acne/skin medications? *

Yes
No

Is your skin dry? *

Yes
No

Are you pregnant? *

Yes
No

Do you have diabetes, phlebitis or skin irritation? *

Yes
No

Is there anything we need to know about you in order to service your needs better?

Please click HERE to read our Agreement and Release of Liability form. Then, sign below. By signing, you are acknowledging that you have read and accept the terms and conditions of the Agreement and Release of Liability.

Client Signature: *

Clear Signature

Website

Well of Life Center for Natural Health, LLC
201 Farm Lane
Doylestown, PA 18901
215-340-3930

Well of Center for Natural Health, LLC
201 Farm Lane
Doylestown, PA 18901
215-340-3930

Copyright© 2015 Well of Life Center for Natural Health, LLC. All rights reserved.

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