J. Roberts Salon logoJ. Roberts SalonRoanoke, VA
Private intake

J. Roberts Salon

Waxing Intake & Consent

Please answer all questions accurately. Your service provider may need to review certain responses before waxing.

Client Information

Date of BirthOptional

Service Provider Preference

We’ll consider your preference when reviewing your selected services and appointment availability.

Select Waxing Service(s)

Select all services you are requesting. Estimated time and pricing update automatically.

Selected Services Summary

No services selected yet.

Requested Appointment Date & Time

These are preferences only and are not confirmed until a coordinator contacts you.

First Choice

Second Choice (optional backup)

Skin & Health Screening

Cleared

Every question requires a Yes or No answer. Any Yes response requires an explanation and flags the intake for review.

1. Are you currently taking or using any medication or topical product that may make your skin more sensitive?
2. Do you currently have a skin condition, rash, irritation, open skin, infection, lesion, or other concern in the area to be waxed?
3. Have you recently had a skin treatment or procedure in the area to be waxed, such as a peel, laser treatment, dermaplaning, microdermabrasion, or strong exfoliation?
4. Is the area to be waxed sunburned, recently heavily tanned, unusually tender, or more sensitive than normal?
5. Are you taking a blood thinner, or do you have a bleeding-related condition that your service provider should know about?
6. Do you have any known allergy or sensitivity to wax, skincare products, adhesives, fragrances, or ingredients that may be used during the service?
7. Are you pregnant or is there a possibility you may be pregnant?
8. Have you ever had an adverse or unexpected reaction to waxing?

Consent & Electronic Signature

Submission date and time will be recorded automatically.