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Man Maintenance

Pre-treatment Client Questionnaire

*First name

*Last name

*Email

*Phone

*Date of Birth

Day

Month

Year

Please indicate if you have any of the following conditions which may restrict waxing. This information will be treated confidentially, along with all your personal data

Conditions or medication affecting your heart or blood (eg haemophilia, swollen veins, blood thinners, etc)

Skin disorders or infections in the area(s) to be waxed (eg eczema, psoriasis, warts, ringworm, etc)

Recent surgery, recent fractures, piercings or tattoos in the area(s) to be waxed

Scar tissue, hairy moles, sunburn, swelling, injuries, areas of tenderness to avoid or any undiagnosed lumps or bumps

Currently using vitamin A skincare (retinol/retinoids), glycolic acid, salicylic acid or other AHA/BHA products in the area(s) to be waxed

Use of steroid creams or medication in the last 3 months

Joint or mobility problems

Conditions or medication affecting your immune system (eg diabetes, cancer treatment, etc)

Nerve Damage or conditions affecting skin sensitivity, including increased and reduced of skin sensation (eg multiple sclerosis, fibromyalgia, trapped/pinched nerve etc)

Recent skin peel, dermabrasion, IPL, laser treatment, Botox, dermal fillers

Allergies or intolerances (eg to sticking plasters, lanolin, aspirin, nuts, essential oils, etc)

Use of Roaccutane, Retin-A, Renova, Treclin, Differin or other acne products in the last 6 months

Easily bruised, sensitive or highly reactive skin

Pregnancy

Other conditions being treated by a medical professional

None of the above

If you have ticked any of the boxes above, please give further details, including timeframes

I undertake to inform Man Maintenance Limited if my answers to any of these questions changes before any treatment is carried out

I acknowledge Man Maintenance Limited has advised me to undertake and offered me a free test patch at least 48 hours before my treatment and I will do so if this is my first time having waxing, I haven't been waxed recently or I have sensitive/allergic skin

I have read, understand and will follow the pre- and post-wax advice in the FAQs section at https://www.manmaintenance.co.uk/faqs

I authorise Man Maintenance to contact me occasionally via email, SMS or phone with offers or other marketing

Client declaration

I confirm that the information provided above 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 aftercare provided by my therapist. I agree to the information I have provided in this questionnaire being retained by Man Maintenance in accordance with the Privacy Policy. I agree to the Personal Hygiene Policy and Cancellation Policy. All policies can be found at https://www.manmaintenance.co.uk/t-cs

*Signature

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- Age Policy

- Personal Hygiene Policy

- Privacy Policy

Consultation Form New

Man Maintenance
Hartington Road
Walthamstow
London E17 8AS

Opening Hours
by appointment

contact@manmaintenance.co.uk

07351 687 554

07351 687 554

@manmaintenancelondon

Copyright Man Maintenance Limited, registered company number 16235081

Terms, Conditions & Policies

- Cancellation Policy

Consultation Form

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