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Client Consultation Form
Gender
*
Male
Female
Have you had a patch test by us?
Yes
No
Did a reaction occur?
*
Yes
No
Did you suffer any adverse reaction?
Yes
No
Are you taking any medications?
Yes
No
If you have checked any of the below problems, then waxing treatment may be restricted or refused and you may be asked to contact your Doctor for advice.
*
Allergies
Diabetes
High/low blood pressure
Varicose veins
Heart condition
Haemophilia
Epilepsy
Heart condition
Radiotherapy
What waxing services would you like today?
Eyebrow
Underarm
Chest
Full leg
Half leg
Chin
Back
Declaration :
I understand that the waxing service I requested involves the application of heated products that may cause an adverse reaction to my hair, skin, or body.
Your Company Name
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Linkedin
Google+
A brief intro is always great. It's Helps people to identify your company.
Address
[email protected]
800-555-0101
yoursite.com