Epilation/Electrolysis Treatment Card

Complexions Beauty Salon

Please complete this form in full. All details are held in confidence and will not be shared without your consent.

Medical History

Present Hair & Skin Condition

I confirm that I understand the treatment and contra-indications, and that the above statements are true, knowing that the electrologist needs the information for correct treatment of my condition, and that the electrologist cannot accept any responsibility for any injury suffered by me attributable to my not having given full and true answers to the above questions.