* Required
Personal Information
First and Last Name*
Phone Number*
Email Address*
Date of birth*
Address*
City*
A Spa to Remember Waxing Form
Would you like to receive text messages of our weekly specials?*
Referred by*
Are you on Instagram? Follow us! @aspatorememberwestford*
Do you have any known allergies?*
Diabetes? *
Are you taking any topical medications? *
Are you taking any oral medications? *
If yes, please list:*
Are you under a Doctor’s care for any skin conditions?*
If yes, please list:*
Are you presently using or have you used any of the following products in the past two weeks?
Check all that apply.
Have you ever experienced an adverse reaction to a waxing treatment?*
If yes, please explain:
Payment Information
We require a 24-hour cancellation notice or appointment rescheduling of all services.
A Charge of 50% of the service will be incurred for all missed appointments.
Please note that this card will only be charged in the case of a same-day cancellation or a no-show appointment, please bring in a separate payment method at the time of your service.
Type of card*
Name on Card*
Card Number*
Expiration Date*
CVC Number*
By entering your name, date and signature below, you are effectively providing your signature,
indicating that all the information on this form is true and accurate, to the best of your knowledge.
Thank you for answering these questions. This information enables us to provide you with the best possible services.
