Carte Blanche
Wax Lounge

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- Contact Us -

To book an appointment, please fill in our form, we will contact you to arrange a date and time suitable to your sechdule, or call us.
For general information or inquiries concerning your appointment please contact us:
E : carteblanchewaxlounge@gmail.com T : 07933 492504

I understand my form is long, but it is important for me to know how to carry out your treatment safely and efficently.

We understand our form is long, but it is important that we know how to carry out your treatment. If you would prefer, we do have this consultation form in paper form in the salon. You will receive a copy of your personal form once completed.

Client Consultation Form

Please fill out the following form as accurately as you can:

First Name

D.O.B

Last Name

Mobile Number

Emergency Contact: Name, Relation & Number

Address

Treatment Areas

Do you suffer from any of the following?

Open Wounds

Asthma

Verrucas

Eczema

Conjunctivitis

Epilepsy

Moles

Sunburn

Impetigo

Cold Sores

Psoriasis

Rashes

Pregnancy

New Scar Tissue

Ringworm

Prescribed Medication

Burns

Non Of The Above

Have you had any of the following treatments recently?

Skin peel

Skin Needling

Microdermabrasion

Glycolic based skincare

Recent filler injections

Non of the above

For any other treatments, please detail:

Are you on any medication taken orally or applied topically? If yes, please provide Details

Retin A

Glycolic Acid

Accutane

Oedema

HRT

Non of the above

Please detail:

Do you have any allergies?

YES

Have you had waxing before?

YES

If yes, please detail:

By signing below you have agreed to the following:

I confirm that the above information is true to the best of my knowledge and belief. I have been fully informed about the expected results and effects of waxing and agree to follow all pre and post aftercare advice provided by my therapist and that can be found on the salon website. I understand that medical conditions, certain medications and topical creams can affect the wax treatment results. I understand that I cannot be waxed if I have certain contraindications and hereby release the waxer and company in which I am voluntarily seeking services. I hereby waiver on my behalf of myself my heirs and any other representatives and all claims of actions, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act of misinformation both intentional or accidentally on this form, as well as failure to follow pre and post-care instructions (found on this salon website) and by the waxer after my service. I hereby give my consent to proceed with treatment.

At Carte Blanche, we have a 48-hour cancellation policy to ensure the best service. No deposit will be refunded for untimely cancellations. Thank you for your cooperation. Please refer to our full cancellation policy on our Terms and Conditions.

Patient signature