📍 BeautyTherapistForms.co.uk🇬🇧 England & WalesVersion 1.0 — 2025
1. Client Details
Full Name
Date of Birth
Contact Number
Email Address
Therapist Name
Treatment Date
2. Medical Contraindications
⚠️ Complete this section honestly. Failure to disclose relevant conditions may result in skin damage or adverse reactions. Your therapist cannot treat areas with active contraindications.
Please tick any that apply to you:
Currently taking Roaccutane (isotretinoin) — ABSOLUTE CONTRAINDICATION. Waxing cannot be performed during treatment or for 6 months after stopping.
Using retinoids (Retin-A, tretinoin, adapalene) — pause required 72 hours minimum before waxing.
Using AHA/BHA exfoliants (glycolic, salicylic acid) on treatment area — pause 48–72 hours.
Active sunburn on treatment area — defer until fully healed.
Active eczema, psoriasis, or dermatitis on treatment area — defer; GP clearance may be required.
Broken, grazed, or infected skin on treatment area — defer until healed.
Diabetes or circulatory conditions — GP clearance required before first treatment.
Blood-thinning medication (warfarin, aspirin therapy, clopidogrel) — proceed with caution; GP clearance recommended.
Recent chemical peel or laser treatment on area — defer 4–6 weeks minimum.
None of the above apply.
Any other skin conditions, allergies, or medications the therapist should be aware of:
3. Patch Test Record
A patch test is required at least 24 hours before first treatment and after any gap of 6+ months.
Test Date
Product / Wax Used
Test Location on Body
Result
Therapist Initials
Client Signature
☐ No Reaction ☐ Mild Reaction ☐ Reaction
☐ No Reaction ☐ Mild Reaction ☐ Reaction
4. Treatment Areas Consent
Please tick all areas to be treated today:
Upper lip
Chin
Eyebrows
Full face
Underarms
Arms
Half leg
Full leg
Bikini line
Hollywood / Brazilian
Back
Chest
Other: [please specify]
5. Aftercare Acknowledgement
I understand and agree to the following aftercare guidelines for 24 hours post-treatment:
Avoid heat (hot baths, sauna, sunbeds, exercise that causes sweating)
Avoid sun exposure on treated areas
Avoid exfoliation or use of AHA/BHA products
Avoid tight clothing on treated areas
Use only gentle, fragrance-free products
6. Therapist's Professional Note
Roaccutane (isotretinoin) is an ABSOLUTE contraindication to waxing. Waxing while on Roaccutane or within 6 months of stopping can cause permanent skin damage, scarring, and skin lift. This applies to all body areas without exception. If a client discloses current or recent Roaccutane use, treatment must not proceed under any circumstances.
7. Declaration & Signatures
I confirm that the information provided above is accurate to the best of my knowledge. I consent to the treatment(s) indicated and acknowledge that I have been given the opportunity to ask questions. I understand the aftercare requirements and accept responsibility for following them.