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Skincare Form

Skincare Consultation Form

Lotus Blossom Organic Spa

Customer Survey

We noticed you haven't visited for awhile! If you have a minute, please take this quick survey so that we can identify areas where we need improvement.


Thank you for your time and effort!


What service did you receive?
What are the reasons you haven't used our services lately?
What could we do to make you consider using our services again?

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Waxing Form

Waxing Consultation Form

To help us provide you with a customized and comfortable wax session, please complete and submit the following consultation form. The information you provide is highly confidential and will not be released to anyone. 


Please remember, as with any hair removal process, some side effects may occur. These may include:

  • Slight tingling or sensitivity

  • Slight inflammation or swelling

  • Numbness or lack of sensation

  • Stinging, redness or bumpiness

  • Wax burn (flaking or scabbing)

  • Bruising

  • Darkening of skin

  • Ingrown hairs

  • Irritation or itchiness with regrowth


Most of these side effects are rare and temporary and can be reduced or eliminated completely with good timing and proper before / after care. For more information on how to ease your worries about waxing, indicate below:

Do you want a copy of WAX FAQ'S emailed to you?
Yes, please ease me!
Nope - been there, waxed that.

Contact Information

Birthday
Select Gender (Optional):

How did you find Lotus Blossom Organic Spa?

Multi choice

About You

What is your genetic/ethnic heritage? (Optional)

List taken from 23&Me. Select all that apply, if known. )

Your Skin

HOW YOU WOULD DESCRIBE IT:

Select all that apply, even if only sporadic.

CAPILLARY ACTIVITY:

Do any of the following pertain to you?

HYDRATION HABITS:

How much plain water do you drink per day?

SENSITIVITY:

Have you experienced any of the following? (REQUIRED)

ALLERGIES:

Have you ever had a negative reaction to any of the following? (REQUIRED)

PRODUCTS:

Are any of the following a part of your daily routine? Select all that apply.

PREFERENCES:

Please select any of the following that determine your choice when purchasing skin care or waxing products.

EXFOLIATION HISTORY:

Have you had any of the following treatments or used any of the following on the area to be waxed?

Lifestyle

Select all that pertain to your current lifestyle. (REQUIRED)

Your Health

Within the last year, have you been under a dermatologist's or other physician's care, undergone any surgery, or had any major health problems? (REQUIRED)
Yes
No

MEDICAL DIAGNOSES:

Please indicate any of the following that apply to you. (REQUIRED)

PRESCRIPTIONS:

Are you taking any of the following medications or prescription skin care products? (REQUIRED)

MEDICAL PROCEDURES:

Have you ever had any of the following surgeries or injections?

PLEASE NOTE: Waxing should precede injections by at least two (2) days.

REPRODUCTIVE:

Select all that pertain to you. (REQUIRED)

Shaver's

Select all that pertain to your shaving habits and experiences (REQUIRED):

Waxer's

Select all that you've experienced due to waxing (REQUIRED):

**Hyper-friction is known as excessive rubbing in one particular area (usually between legs or under arms) causing inflammation and discoloration of the skin. Over time this ongoing process deteriorates the epidermis, causing skin to become hard (keratinization) and dark (hyperpigmentation). In addition to the normal salt and bacteria in underarm sweat, excessive deodorant application may cause discoloration, especially those prone to fragrance sensitivity. Improper waxing preparation, as when powder is applied instead of pre-wax oil, can also lead to hyper-friction over time. 

Would you be interested in an intimate brightening treatment? AKA: "Vagacial"/Bikini Peel/Bikini Groom & Soothe (includes extractions)?

Please Note:

Our establishment does NOT "double dip" the wax sticks. This is considered un-hygienic and against state board regulations. Regardless, it is important to know that if you're having any active symptoms of an STI like genital warts due to HPV or sores due to herpes you should avoid getting waxed until the symptoms subside. Also avoid waxing if you have prodromal herpes symptoms (signs that an outbreak is coming), like itching or tingling.

My signature below constitutes my acknowledgement that:

Peel
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