Skip to content

Home
About
- FAQ
Services
Dr. Jedynak-Bell
Cherry Payment Plans
Contact

Home
About
- FAQ
Services
Dr. Jedynak-Bell
Cherry Payment Plans
Contact

Home
About
- FAQ
Services
Dr. Jedynak-Bell
Cherry Payment Plans
Contact

Browse Services

Waxing Consent

Relax Your Body ~ Rejuvenate Your Mind ~ Renew Your Spirit.

Microdermabrasion Information Sheet - Discover the rejuvenating power of our natural ingredient facials

Name

Address

Address Line 1

City

State

Zip Code

Home Phone

Work Phone:

Email address: *

Have you used any Alpha Hydroxy Acid (AHA) or glycolic products in the past 48-72 hours?

Yes
No

Are you using Retin-a, Renova or Accutane (an oral form of Retin-a)?

Yes
No

Are you using any other skin thinning products and/or drugs?

Yes
No

Are you exposed to the sun on a daily basis or are you considering spending more time in the sun soon?

Yes
No

Do you use a tanning bed?

Yes
No

Are you diabetic?

Yes
No

Are you currently taking medications? If so, please list all (including over the counter drugs/herbal supplements):

What skin products do you regularly use on your skin?

Have you ever been treated for cancer? If yes, when and what types of therapies were used?

Please list any other illness/condition you are currently being treated for by a medical professional

Section Divider

When is your next menstrual cycle due to begin? *

(Always allow five days for menstrual cycle. Because of water retention and for your own personal comfort, you should avoid hair removal two days before your cycle is due and two days after it is completed.)

Please note that waxing does have certain side effects such as skin removal, redness, swelling, tenderness, etc.

Checkboxes *

I have read the above information and if I have any concerns, I will address these with my skin therapist. I give permission to my therapist to perform the waxing procedure we have discussed and will hold her and her staff harmless from any liability that may result from this treatment.
I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.
I have read and understand the post-treatment home care instructions. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product / post-treatment care, I will consult the esthetician immediately
I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered.
I understand the procedure and accept the risks. I do not hold the esthetician, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.

Client Name (printed)

Date *

Date

All Services are By Appointment Only

Come, escape the hustle and bustle, and immerse yourself in a world of relaxation and luxury. Book your appointment today and embark on a journey to rejuvenation at our exquisite spa.

Relax and Unwind At Our All Natural Boutique Spa!

At Botanical Healing Wellness Spa we offer a broad variety of luxurious soothing spa treatments from facials, body massage, sauna, and other relaxing treatments.

To enhance your treatments spend some time in our jacuzzi, or indulge in a detoxifying Yoni Steam session. Visit our mini resort like spa today, and experience pure bliss with our one on one pampering.

Quick Links

Facials
Massage
Waxing
Body Scrubs & Wraps
Yoni Steam
Micropigmentation
Microneedling

Business Hours

Monday : 9am -9pm
Tuesday : 9am -9pm
Wednesday : 9am -9pm
Thursday : 9am -9pm
Friday : 9am -9pm
Saturday : 9am -9pm
Sunday: 9am - 9pm

Contact Info

5935 N 195th Dr, Litchfield Park, AZ, 85340
By Appointment Only
info@botanicalhealingwellnessspa.com
(623)-248-8258

Copyright © 2025 BOTANICAL HEALING WELLNESS SPA | Powered by BOTANICAL HEALING WELLNESS SPA