Please Update & Confirm Your Details Below: First Name * Last Name * Email * Date of Birth * How did you find us? Please select oneGoogleFacebookWord of MouthWalked By Street Address * County * Town/City * Post Code * Please indicate whether any of the following apply to you: Recent treatment from your doctor or another healthcare practitioner * Yes No Current medication (prescribed, over-the- counter or supplements) * Yes No Recent scar tissue, cuts, bruises or other abrasions to the area being treated * Yes No Skin disorders or infections (e.g. eczema, psoriasis, ringworm, STIs etc) * Yes No Sunburn or heat allergies * Yes No Hypersensitive or highly-reactive skin * Yes No Use of steroid creams or steroid medication in the last 3 months * Yes No Varicose veins or capillary damage in treatment area * Yes No Haemophilia * Yes No Heart conditions * Yes No High/low blood pressure * Yes No Diabetes * Yes No Oedema or other swelling in treatment area * Yes No Nerve damage or increased/decreased sensitivity in the skin * Yes No Epilepsy, fits or fainting attacks * Yes No Allergies or intolerances (e.g. to lanolin, sticking plasters etc) * Yes No Conditions or medical treatment caused immuno-suppression * Yes No Pregnancy * Yes No Previous reactions to waxing * Yes No Use of Roaccutane or other acne products in the last 6 months * Yes No Chemical peel, microdermabrasion, laser or light therapy in the last month * Yes No “Current or recent use of any products that contain any glycolic acid, lactic acid, salicylic acid, hydroxyl acid or Vitamin A derivatives (e.g. Retinol)? ” * Yes No If you’ve answered YES to any of the questions above, please enter any details in the box below: I confirm that the above information is true to the best of my knowledge, information and belief and that I will advise you of any subsequent change in my medical condition, so that you may continue to treat me in the most effective manner. I understand that all beauty treatments carry a risk of adverse reaction. In the absence of any negligence or other breach of duty by StripTweeze Limited, I confirm that the undertaking of any treatment is entirely at my own risk.
