Lavender Falls Face & Body Spa LLC

Client Informed Consent Form






19211 Huebner Rd Suite # 3

San Antonio, Texas 78258

Phone: 210-446-0903


Online Booking Available

Treatment Consists of:

Wax is applied to the skin and clings to the hairs. When wax is removed, the hairs are stuck to the wax, leaving your skin smooth. Hair regrowth becomes softer and results last longer than other forms of hair removal.

Please go 1-2 weeks without shaving or waxing and have at least ¼ inch of hair for best results.

Waxing can be painful If you are sensitive to discomfort try taking an over-the-counter pain reliever like Tylenol or Advil 30 minutes before your appointment.

Clients Who Should NOT Be Treated:

I do not have any open skin lesions or active herpes outbreak (cold sore or genital)

Sensitive skin can burn from waxing procedures.

Accutane and Retin-A or Tretinoin are drying to the skin; therefore, waxing may lead to removal of skin, which may cause scarring. Waxing over sunburned or very tanned skin may lead to removal of the skin, which may cause scarring.

Diabetics have a very hard time healing when a wound or lesion occurs to the skin, as the immune system is unable to function fully to fighting bacteria.

Allergies to any of the product ingredients used in waxing may cause severe allergic reaction

Medical Information: I acknowledge I am not currently nor have used any of the products listed below within the time frame listed.

Pre-Treatment Acknowledgement

      Accutane with the last year

      Allergies -I am not allergic to any of the ingredients in the prescribed treatment.

      Sunburn or Sun Exposure- 1 week prior to treatment.

      Recent Laser Treatments or Chemical Peels

      No skin thinning products, abrasive scrubs or strong exfoliants – 3 days prior to and post treatment.

(Retin-A, Renova, Differin (Adapalene 0.1%), Tazorac or any product containing Retinol, glycolic acid, salicylic acid)

      Any products containing AHA or BHA, or benzyl peroxide or any exfoliating products that may be drying or irritating – 3 days prior to treatment.

      Chemotherapy or radiation therapy


      Women: Notify your aesthetician if you are currently on your menstrual cycle or due to start in the next two days.

*Notify your aesthetician of any medical conditions & medications (Current & within the last 90 days).

Post Treatment Acknowledgement

      It is best to avoid all active skincare products in the waxed area for 24-48 hours

      It is best to avoid sun exposure or overheating the area.

      Sun protection of at least broad spectrum SPF 30 is recommended.


Side Effects:

Possible side effects include but are not limited to:

• It is common to experience redness after waxing. In some cases, swelling, bumps or mild tenderness may also occur but these are temporary and generally fade within 72 hours.

•In rare cases skin removal can occur, which may cause scarring.


      I understand that any time the skin barrier is compromised; there is a small risk of infection. I will contact my aesthetician immediately should this happen.

      The Waxing treatment has been fully explained and any questions or concerns that I have, have been addressed.

      I acknowledge that no guarantee has been given to me as to the condition of the complexion, skin pore size, wrinkles or the percentage of improvement expected following treatment, due to each individual’s unique reactions.

      I acknowledge this procedure is strictly an elective cosmetic procedure and that no medical claims have been expressed or implied.

      Photographs May be taken for comparison for future treatments for my chart.


I have read the above and understand it. My provider has answered my questions satisfactorily. I accept the possible risks and complications of the treatment.


I acknowledge that Lavender Falls Face and Body Spa has a no-refund policy on any products or service. There will be no refunds for any reason.


All services performed are without any guarantee. By continuing with service, you are confirming that you have read and understand our no refunds policy.







Lavender Falls Face and Body Spa LLC

Thank you for choosing and trusting Lavender Falls Face & Body Spa LLC for your aesthetic needs

Feel free to contact us at 210-446-0903 if you have any questions




Leave this empty:

Lavender Falls Spa San Antonio | Eyelash Extensions | Facial Spa | Permanent Cosmetics | 3D Eyebrow Microblading http://sanantonio.lavenderskinspa.com
Signature Certificate
Document name: Wax
Unique Document ID: 44154b7333aa864546fea8f6338e86e36908cc6c
Timestamp Audit
2017-04-08 19:09:09 CDTWax Uploaded by Lavender Falls Face and Body Spa LLC. - lavenderfallstx@gmail.com IP