TULSA’S LEADING, ALL WAXING STUDIO! Release Form  1 Step 1 First Name(Required) Last Name(Required) Date(Todays Date)date_range Date of Birth(Required) Addressyour full name Email(Required)email City(Required) State(Required)OklahomaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip(Required) Cell Phone(Optional) Waxing/Health HistoryPlease check all that apply Have you had waxing done before?YesNo If so, what areas?0 / Have you ever experienced any reaction or breakout from waxing?YesNo If so, please describe0 / Have you used any products in the area(s) to be waxed?YesNo If so, what kind?0 / Do you currently use sunscreen?YesNo Do you currently tan (Indoors or Outdoors)?YesNo If so, date last tanneddate_range Do you develop cold sores/fever blisters?YesNo If so, date of last breakoutdate_range Is your menstrual period due within the next week?YesNo Have you ever used Renova, Differin, or Tazorac?YesNo If so, date of last usedate_range Have you ever used Retin-A?YesNo If so, date of last usedate_range Have you ever used any topical medications or AHAs?YesNo If so, date of last usedate_range Have you ever used Accutane?YesNo If so, date of last usedate_range Have you recently had a MicrodermabrasionYesNo If so, date of last treatmentdate_range Have you recently had a chemical peel?YesNo If so, date of last treatmentdate_range Have you ever had laser treatments?YesNo If so, date of last treatmentdate_range Please list any medications you may be taking at this time0 / Known allergies0 / I understand that I must avoid direct sunlight for at least 24 hours and wear at least SPF 25 for 48 hours post-treatment. I further understand that some redness, irritation, ingrown hairs, and small white bumps may occur and that waxing may stimulate the activity of cold sores and fever blisters. I understand that the aftercare instructions given will be followed and Rio Premier Waxing Studio will not be held liable if performed otherwise. I understand the procedure of waxing and/or Brazilian wax, that will be performed during my appointment, and I will not hold Rio Reinhardt or any other staff member and "Rio Premier Waxing Studio" or any affiliates liable for any type of reaction that may occur. I agree to not take any video or pictures while I am in the Estheticians room. I am at least 18 years of age or have a parent or guardian present. By checking this box, I understand everything I have read above. How did you hear about us?0 / Submit Form keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder Rio Premier Waxing Studio 3807-L South Peoria AvenueTulsa, OK 74105Phone: 918.895.6514Email: email@example.com Hours By Appointment Only Book Now!