Waxing + Tinting Please enable JavaScript in your browser to complete this form.Name *Date of Birth *Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMobile Phone *Alternative PhoneEmail *Text Alerts? *YesNoEmail Alerts? *YesNoEmergency Contact *Emergency Contact Phone *How did you hear about us?SignWebsiteFacebookInstagramInternetAdReferred ByWhat are your interests?BrowsBody WaxingFacialsLash ExtensionsKeratin Lash LiftAre you currently using any topical over-the-counter or prescription medications for Acne on your face? *YesNoPlease list your topical over-the-counter or prescription medications for Acne *Have you had any waxing abrasions in the past? *YesNoPlease list when you had wax abrasions *Are you taking any oral medications that may cause sensitivity to sunlight? *YesNoPlease list when you had oral medications that may cause sensitivity to sunlight *Have you had any recent microdermabrasion treatments, chemical peels or sunburn on your face in the past 2 weeks? *YesNoPlease list any and all recent microdermabrasion treatments, chemical peels or sunburn on your face in the past 2 weeks *Are you currently using any skin care products containing retinol or any anti-aging or resurfacing products? *YesNoPlease list the skin care products containing retinol or any anti-aging or resurfacing products *Do you have any allergies? *YesNoPlease list your allergies *I am aware I must wait 24 hours before receiving any kind of service or treatment at Arch Brow Bar if I have received Botox and/or cosmetic fillers of any kind. I agree to update my browista/technician at every future appointment, PLEASE INITIAL *I am aware waxing may cause redness, swelling, breakouts, hives, skin tearing, and skin irritation, PLEASE INITIAL *Please inform your Browista or technician of any changes in your skin care routine as changes may affect your skin, PLEASE INITIAL *Date *Signature *Clear SignatureSubmit