{"id":271467,"date":"2024-02-23T21:01:54","date_gmt":"2024-02-23T21:01:54","guid":{"rendered":"https:\/\/lavidamassagefortcollinsco.com\/?page_id=271467"},"modified":"2024-06-21T18:32:19","modified_gmt":"2024-06-21T18:32:19","slug":"waxing-intake-form","status":"publish","type":"page","link":"https:\/\/lavidamassagefortcollinsco.com\/forms\/waxing-intake-form\/","title":{"rendered":"Waxing Intake Form"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text _builder_version=&#8221;4.25.1&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; custom_margin=&#8221;|0px||0px|false|false&#8221; custom_padding=&#8221;|0px||0px|false|false&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context 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d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework massage-intake-form_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_10' style='display:none'><div id='gf_10' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Waxing Intake Form<\/h2>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_10' id='gform_10' class='massage-intake-form' action='\/wp-json\/wp\/v2\/pages\/271467#gf_10' data-formid='10' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_10_18\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_18\" ><h3 class=\"gsection_title\">Contact<\/h3><\/div><fieldset id=\"field_10_5\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_5\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_5'>\n                            \n                            <span id='input_10_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.3' id='input_10_5_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_5_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_5_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.6' id='input_10_5_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_5_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_7\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_7\" ><label class='gfield_label gform-field-label' for='input_10_7'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_7' id='input_10_7' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_8\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_8\" ><label class='gfield_label gform-field-label' for='input_10_8'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_10_8' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_10\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Phone Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_10_10'><div class='gchoice gchoice_10_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='Home'  id='choice_10_10_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_1' id='label_10_10_1' class='gform-field-label gform-field-label--type-inline'>Home<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='Mobile'  id='choice_10_10_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_2' id='label_10_10_2' class='gform-field-label gform-field-label--type-inline'>Mobile<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.3' type='checkbox'  value='Work'  id='choice_10_10_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_3' id='label_10_10_3' class='gform-field-label gform-field-label--type-inline'>Work<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.4' type='checkbox'  value='Other'  id='choice_10_10_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_4' id='label_10_10_4' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_44\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_44\" ><legend class='gfield_label gform-field-label' >It&#039;s OK to text me!<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_44'>\n\t\t\t<div class='gchoice gchoice_10_44_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='Yes'  id='choice_10_44_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_44_0' id='label_10_44_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_44_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='No'  id='choice_10_44_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_44_1' id='label_10_44_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_11\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_11\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_10_11' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_10_11_1_container' >\n                                        <input type='text' name='input_11.1' id='input_10_11_1' value=''    aria-required='true'    \/>\n                                        <label for='input_10_11_1' id='input_10_11_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_10_11_3_container' >\n                                    <input type='text' name='input_11.3' id='input_10_11_3' value=''    aria-required='true'    \/>\n                                    <label for='input_10_11_3' id='input_10_11_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_10_11_4_container' >\n                                        <select name='input_11.4' id='input_10_11_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_10_11_4' id='input_10_11_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_10_11_5_container' >\n                                    <input type='text' name='input_11.5' id='input_10_11_5' value=''    aria-required='true'    \/>\n                                    <label for='input_10_11_5' id='input_10_11_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_11.6' id='input_10_11_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_10_99\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_99\" ><label class='gfield_label gform-field-label' for='input_10_99'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_99' id='input_10_99' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_17\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_17\" ><h3 class=\"gsection_title\">History<\/h3><\/div><div id=\"field_10_51\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_51\" ><label class='gfield_label gform-field-label' for='input_10_51'>When was your last wax?<\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_10_51' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_52\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_52\" ><label class='gfield_label gform-field-label' for='input_10_52'>When was your last facial hair removal?<\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_10_52' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_54\" ><legend class='gfield_label gform-field-label' >Method of Removal<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_54'>\n\t\t\t<div class='gchoice gchoice_10_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Chemical Removal'  id='choice_10_54_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_54_0' id='label_10_54_0' class='gform-field-label gform-field-label--type-inline'>Chemical Removal<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Laser'  id='choice_10_54_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_54_1' id='label_10_54_1' class='gform-field-label gform-field-label--type-inline'>Laser<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_54_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Shaving'  id='choice_10_54_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_54_2' id='label_10_54_2' class='gform-field-label gform-field-label--type-inline'>Shaving<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_54_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Waxing'  id='choice_10_54_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_54_3' id='label_10_54_3' class='gform-field-label gform-field-label--type-inline'>Waxing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_54_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Threading'  id='choice_10_54_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_54_4' id='label_10_54_4' class='gform-field-label gform-field-label--type-inline'>Threading<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_54_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Depilation'  id='choice_10_54_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_54_5' id='label_10_54_5' class='gform-field-label gform-field-label--type-inline'>Depilation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_54_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='gf_other_choice'  id='choice_10_54_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_54_6' id='label_10_54_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_10_54_other' class='gchoice_other_control' name='input_54_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_100\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_100\" ><label class='gfield_label gform-field-label' for='input_10_100'>What body part(s) would you like waxed today?<\/label><div class='ginput_container ginput_container_text'><input name='input_100' id='input_10_100' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_25\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_25\" ><label class='gfield_label gform-field-label' for='input_10_25'>FEMALE GUESTS - When was your last menstrual cycle start date?<\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_10_25' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_79\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_79\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Do you have or are you prone to?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_10_79'><div class='gchoice gchoice_10_79_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.1' type='checkbox'  value='Ingrown Hairs'  id='choice_10_79_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_79_1' id='label_10_79_1' class='gform-field-label gform-field-label--type-inline'>Ingrown Hairs<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_79_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.2' type='checkbox'  value='Scarring'  id='choice_10_79_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_79_2' id='label_10_79_2' class='gform-field-label gform-field-label--type-inline'>Scarring<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_79_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.3' type='checkbox'  value='Bumps'  id='choice_10_79_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_79_3' id='label_10_79_3' class='gform-field-label gform-field-label--type-inline'>Bumps<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_79_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.4' type='checkbox'  value='Hyperpigmentation'  id='choice_10_79_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_79_4' id='label_10_79_4' class='gform-field-label gform-field-label--type-inline'>Hyperpigmentation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_79_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.5' type='checkbox'  value='Bruising'  id='choice_10_79_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_79_5' id='label_10_79_5' class='gform-field-label gform-field-label--type-inline'>Bruising<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_101\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_101\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Do you use any of the following?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_10_101'><div class='gchoice gchoice_10_101_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.1' type='checkbox'  value='Accutane'  id='choice_10_101_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_101_1' id='label_10_101_1' class='gform-field-label gform-field-label--type-inline'>Accutane<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_101_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.2' type='checkbox'  value='Retin-A'  id='choice_10_101_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_101_2' id='label_10_101_2' class='gform-field-label gform-field-label--type-inline'>Retin-A<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_101_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.3' type='checkbox'  value='Alpha-hydroxy Acid'  id='choice_10_101_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_101_3' id='label_10_101_3' class='gform-field-label gform-field-label--type-inline'>Alpha-hydroxy Acid<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_101_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.4' type='checkbox'  value='Glycolic Acid'  id='choice_10_101_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_101_4' id='label_10_101_4' class='gform-field-label gform-field-label--type-inline'>Glycolic Acid<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_101_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.5' type='checkbox'  value='Resorcinol'  id='choice_10_101_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_101_5' id='label_10_101_5' class='gform-field-label gform-field-label--type-inline'>Resorcinol<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_101_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.6' type='checkbox'  value='Scrub or Peel'  id='choice_10_101_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_101_6' id='label_10_101_6' class='gform-field-label gform-field-label--type-inline'>Scrub or Peel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_101_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.7' type='checkbox'  value='I use a tanning bed'  id='choice_10_101_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_101_7' id='label_10_101_7' class='gform-field-label gform-field-label--type-inline'>I use a tanning bed<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_102\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_102\" ><label class='gfield_label gform-field-label' for='input_10_102'>Have you ever been treated for cancer? If so, when?<\/label><div class='ginput_container ginput_container_text'><input name='input_102' id='input_10_102' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_64\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_64\" ><legend class='gfield_label gform-field-label' >Do you have diabetes or any other skin compromising condition?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_64'>\n\t\t\t<div class='gchoice gchoice_10_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Yes'  id='choice_10_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_64_0' id='label_10_64_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='No'  id='choice_10_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_64_1' id='label_10_64_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_26\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_26\" ><label class='gfield_label gform-field-label' for='input_10_26'>List any other illness\/condition you are presently experiencing or being seen by a doctor for:<\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_10_26' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_81\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_81\" ><legend class='gfield_label gform-field-label' >Are you using any skin thinning products or drugs?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_81'>\n\t\t\t<div class='gchoice gchoice_10_81_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Yes'  id='choice_10_81_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_81_0' id='label_10_81_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_81_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='No'  id='choice_10_81_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_81_1' id='label_10_81_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_82\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_82\" ><label class='gfield_label gform-field-label' for='input_10_82'>If yes, please specify<\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_10_82' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_80\" ><legend class='gfield_label gform-field-label' >Have you used any Retinol\/Retin-A\/Tretinoin\/Accutane\/AHA\u2019s on the area to be waxed in the past week?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_80'>\n\t\t\t<div class='gchoice gchoice_10_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Yes'  id='choice_10_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_80_0' id='label_10_80_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='No'  id='choice_10_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_80_1' id='label_10_80_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_83\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_83\" ><label class='gfield_label gform-field-label' for='input_10_83'>If yes, when and how often?<\/label><div class='ginput_container ginput_container_text'><input name='input_83' id='input_10_83' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_84\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_84\" ><legend class='gfield_label gform-field-label' >Have you used any other skin thinning medications?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_84'>\n\t\t\t<div class='gchoice gchoice_10_84_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='Yes'  id='choice_10_84_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_84_0' id='label_10_84_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_84_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='No'  id='choice_10_84_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_84_1' id='label_10_84_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_85\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_85\" ><label class='gfield_label gform-field-label' for='input_10_85'>If yes, which ones?<\/label><div class='ginput_container ginput_container_text'><input name='input_85' id='input_10_85' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_103\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_103\" ><b>New use of any of the medications listed above increases the possibility of a reaction.<p>\nPlease inform the Esthetician if you have begun taking any new medications since your last session.<\/div><div id=\"field_10_105\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_105\" ><h3 class=\"gsection_title\">Body\/Facial Waxing Disclosure<\/h3><\/div><fieldset id=\"field_10_104\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_104\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Please check to acknowledge each line below<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_10_104'><div class='gchoice gchoice_10_104_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.1' type='checkbox'  value='I understand that the use of any medications increases the possibility of a reaction.'  id='choice_10_104_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_104_1' id='label_10_104_1' class='gform-field-label gform-field-label--type-inline'>I understand that the use of any medications increases the possibility of a reaction.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_104_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.2' type='checkbox'  value='I understand that waxing can have certain side effects such as skin lifting\/removal, redness, scabbing, bruising, scarring, swelling, tenderness, hyperpigmentation, and\/or breakouts.'  id='choice_10_104_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_104_2' id='label_10_104_2' class='gform-field-label gform-field-label--type-inline'>I understand that waxing can have certain side effects such as skin lifting\/removal, redness, scabbing, bruising, scarring, swelling, tenderness, hyperpigmentation, and\/or breakouts.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_104_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.3' type='checkbox'  value='I understand that waxing soft tissue may cause the skin to tear resulting in the need for stitches. The most common occurrence of this is in a Brazilian bikini wax.'  id='choice_10_104_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_104_3' id='label_10_104_3' class='gform-field-label gform-field-label--type-inline'>I understand that waxing soft tissue may cause the skin to tear resulting in the need for stitches. The most common occurrence of this is in a Brazilian bikini wax.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_104_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.4' type='checkbox'  value='I will arrive showered, with hair trimmed 1\/4 to 1\/2 inch (trimming is an additional charge).'  id='choice_10_104_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_104_4' id='label_10_104_4' class='gform-field-label gform-field-label--type-inline'>I will arrive showered, with hair trimmed 1\/4 to 1\/2 inch (trimming is an additional charge).<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_104_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.5' type='checkbox'  value='I have not shaved for three weeks before my wax appointment.'  id='choice_10_104_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_104_5' id='label_10_104_5' class='gform-field-label gform-field-label--type-inline'>I have not shaved for three weeks before my wax appointment.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_104_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.6' type='checkbox'  value='I will refrain from tanning 48 hours before and after my appointment to reduce the risk of hyperpigmentation.'  id='choice_10_104_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_104_6' id='label_10_104_6' class='gform-field-label gform-field-label--type-inline'>I will refrain from tanning 48 hours before and after my appointment to reduce the risk of hyperpigmentation.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_106\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_106\" >I have read the above information and I have addressed any concerns with my Esthetician. I give permission to my practitioner to perform the waxing procedure we have discussed and will hold them 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.<p>\nI have read and understand the post-treatment home care instructions. I am willing to follow the recommendations made by my Esthetician for a home care regimen that can minimize or eliminate possible negative reactions. If I have additional questions or concerns regarding my treatment or suggested home product\/post-treatment care, I will consult my Esthetician immediately.\n<p>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 LaVida Massage or the Esthetician responsible for any of my conditions that were present, but not disclosed at the time of this skincare procedure, which may be affected by the treatment performed today.<\/div><div id=\"field_10_42\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_42\" ><label class='gfield_label gform-field-label' for='input_10_42'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_10_42_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><input type='hidden' class='gform_hidden' name='input_10_42_valid' id='input_10_42_valid' \/><canvas id='input_10_42' width='300' height='180'><\/canvas><\/div><\/div><\/div><div id=\"field_10_107\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_107\" ><label class='gfield_label gform-field-label' for='input_10_107'>Comments<\/label><div class='ginput_container'><input name='input_107' id='input_10_107' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_10_107'>This field is for validation purposes and should be left unchanged.<\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_10' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' value='submit'  \/> <input type='hidden' name='gform_ajax' value='form_id=10&amp;title=1&amp;description=&amp;tabindex=0&amp;theme=gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_10' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_10' id='gform_theme_10' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_10' id='gform_style_settings_10' value='' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_10' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='10' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_10' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_10' id='gform_target_page_number_10' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_10' id='gform_source_page_number_10' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_10' id='gform_ajax_frame_10' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 10, 'https:\/\/lavidamassagefortcollinsco.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_10').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_10');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_10').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_10').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_10').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_10').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_10').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_10').val();gformInitSpinner( 10, 'https:\/\/lavidamassagefortcollinsco.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [10, current_page]);window['gf_submitting_10'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_10').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_10').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [10]);window['gf_submitting_10'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_10').text());}else{jQuery('#gform_10').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"10\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);                if (event && event.defaultPrevented) {                return;         }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_10\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_10\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_10\" );        let postRenderFired = false;                function triggerPostRender() {            if ( postRenderFired ) {                return;            }            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*\/\n<\/script>\n\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework massage-intake-form_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_10' style='display:none'><div id='gf_10' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Waxing Intake Form<\/h2>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_10' id='gform_10' class='massage-intake-form' action='\/wp-json\/wp\/v2\/pages\/271467#gf_10' data-formid='10' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_10_18\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_18\" ><h3 class=\"gsection_title\">Contact<\/h3><\/div><fieldset id=\"field_10_5\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_5\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_5'>\n                            \n                            <span id='input_10_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.3' id='input_10_5_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_5_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_5_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.6' id='input_10_5_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_5_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_7\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_7\" ><label class='gfield_label gform-field-label' for='input_10_7'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_7' id='input_10_7' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_8\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_8\" ><label class='gfield_label gform-field-label' for='input_10_8'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_10_8' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_10\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Phone Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_10_10'><div class='gchoice gchoice_10_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='Home'  id='choice_10_10_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_1' id='label_10_10_1' class='gform-field-label gform-field-label--type-inline'>Home<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='Mobile'  id='choice_10_10_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_2' id='label_10_10_2' class='gform-field-label gform-field-label--type-inline'>Mobile<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.3' type='checkbox'  value='Work'  id='choice_10_10_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_3' id='label_10_10_3' class='gform-field-label gform-field-label--type-inline'>Work<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.4' type='checkbox'  value='Other'  id='choice_10_10_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_4' id='label_10_10_4' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_44\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_44\" ><legend class='gfield_label gform-field-label' >It&#039;s OK to text me!<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_44'>\n\t\t\t<div class='gchoice gchoice_10_44_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='Yes'  id='choice_10_44_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_44_0' id='label_10_44_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_44_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='No'  id='choice_10_44_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_44_1' id='label_10_44_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_11\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_11\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_10_11' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_10_11_1_container' >\n                                        <input type='text' name='input_11.1' id='input_10_11_1' value=''    aria-required='true'    \/>\n                                        <label for='input_10_11_1' id='input_10_11_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_10_11_3_container' >\n                                    <input type='text' name='input_11.3' id='input_10_11_3' value=''    aria-required='true'    \/>\n                                    <label for='input_10_11_3' id='input_10_11_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_10_11_4_container' >\n                                        <select name='input_11.4' id='input_10_11_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_10_11_4' id='input_10_11_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_10_11_5_container' >\n                                    <input type='text' name='input_11.5' id='input_10_11_5' value=''    aria-required='true'    \/>\n                                    <label for='input_10_11_5' id='input_10_11_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_11.6' id='input_10_11_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_10_99\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_99\" ><label class='gfield_label gform-field-label' for='input_10_99'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_99' id='input_10_99' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_17\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_17\" ><h3 class=\"gsection_title\">History<\/h3><\/div><div id=\"field_10_51\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_51\" ><label class='gfield_label gform-field-label' for='input_10_51'>When was your last wax?<\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_10_51' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_52\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_52\" ><label class='gfield_label gform-field-label' for='input_10_52'>When was your last facial hair removal?<\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_10_52' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_54\" ><legend class='gfield_label gform-field-label' >Method of Removal<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_54'>\n\t\t\t<div class='gchoice gchoice_10_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Chemical Removal'  id='choice_10_54_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_54_0' id='label_10_54_0' class='gform-field-label gform-field-label--type-inline'>Chemical Removal<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Laser'  id='choice_10_54_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_54_1' id='label_10_54_1' class='gform-field-label gform-field-label--type-inline'>Laser<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_54_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Shaving'  id='choice_10_54_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_54_2' id='label_10_54_2' class='gform-field-label gform-field-label--type-inline'>Shaving<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_54_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Waxing'  id='choice_10_54_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_54_3' id='label_10_54_3' class='gform-field-label gform-field-label--type-inline'>Waxing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_54_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Threading'  id='choice_10_54_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_54_4' id='label_10_54_4' class='gform-field-label gform-field-label--type-inline'>Threading<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_54_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Depilation'  id='choice_10_54_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_54_5' id='label_10_54_5' class='gform-field-label gform-field-label--type-inline'>Depilation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_54_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='gf_other_choice'  id='choice_10_54_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_54_6' id='label_10_54_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_10_54_other' class='gchoice_other_control' name='input_54_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_100\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_100\" ><label class='gfield_label gform-field-label' for='input_10_100'>What body part(s) would you like waxed today?<\/label><div class='ginput_container ginput_container_text'><input name='input_100' id='input_10_100' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_25\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_25\" ><label class='gfield_label gform-field-label' for='input_10_25'>FEMALE GUESTS - When was your last menstrual cycle start date?<\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_10_25' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_79\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_79\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Do you have or are you prone to?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_10_79'><div class='gchoice gchoice_10_79_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.1' type='checkbox'  value='Ingrown Hairs'  id='choice_10_79_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_79_1' id='label_10_79_1' class='gform-field-label gform-field-label--type-inline'>Ingrown Hairs<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_79_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.2' type='checkbox'  value='Scarring'  id='choice_10_79_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_79_2' id='label_10_79_2' class='gform-field-label gform-field-label--type-inline'>Scarring<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_79_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.3' type='checkbox'  value='Bumps'  id='choice_10_79_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_79_3' id='label_10_79_3' class='gform-field-label gform-field-label--type-inline'>Bumps<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_79_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.4' type='checkbox'  value='Hyperpigmentation'  id='choice_10_79_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_79_4' id='label_10_79_4' class='gform-field-label gform-field-label--type-inline'>Hyperpigmentation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_79_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.5' type='checkbox'  value='Bruising'  id='choice_10_79_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_79_5' id='label_10_79_5' class='gform-field-label gform-field-label--type-inline'>Bruising<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_101\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_101\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Do you use any of the following?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_10_101'><div class='gchoice gchoice_10_101_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.1' type='checkbox'  value='Accutane'  id='choice_10_101_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_101_1' id='label_10_101_1' class='gform-field-label gform-field-label--type-inline'>Accutane<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_101_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.2' type='checkbox'  value='Retin-A'  id='choice_10_101_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_101_2' id='label_10_101_2' class='gform-field-label gform-field-label--type-inline'>Retin-A<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_101_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.3' type='checkbox'  value='Alpha-hydroxy Acid'  id='choice_10_101_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_101_3' id='label_10_101_3' class='gform-field-label gform-field-label--type-inline'>Alpha-hydroxy Acid<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_101_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.4' type='checkbox'  value='Glycolic Acid'  id='choice_10_101_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_101_4' id='label_10_101_4' class='gform-field-label gform-field-label--type-inline'>Glycolic Acid<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_101_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.5' type='checkbox'  value='Resorcinol'  id='choice_10_101_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_101_5' id='label_10_101_5' class='gform-field-label gform-field-label--type-inline'>Resorcinol<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_101_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.6' type='checkbox'  value='Scrub or Peel'  id='choice_10_101_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_101_6' id='label_10_101_6' class='gform-field-label gform-field-label--type-inline'>Scrub or Peel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_101_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_101.7' type='checkbox'  value='I use a tanning bed'  id='choice_10_101_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_101_7' id='label_10_101_7' class='gform-field-label gform-field-label--type-inline'>I use a tanning bed<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_102\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_102\" ><label class='gfield_label gform-field-label' for='input_10_102'>Have you ever been treated for cancer? If so, when?<\/label><div class='ginput_container ginput_container_text'><input name='input_102' id='input_10_102' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_64\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_64\" ><legend class='gfield_label gform-field-label' >Do you have diabetes or any other skin compromising condition?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_64'>\n\t\t\t<div class='gchoice gchoice_10_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Yes'  id='choice_10_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_64_0' id='label_10_64_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='No'  id='choice_10_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_64_1' id='label_10_64_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_26\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_26\" ><label class='gfield_label gform-field-label' for='input_10_26'>List any other illness\/condition you are presently experiencing or being seen by a doctor for:<\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_10_26' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_81\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_81\" ><legend class='gfield_label gform-field-label' >Are you using any skin thinning products or drugs?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_81'>\n\t\t\t<div class='gchoice gchoice_10_81_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Yes'  id='choice_10_81_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_81_0' id='label_10_81_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_81_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='No'  id='choice_10_81_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_81_1' id='label_10_81_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_82\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_82\" ><label class='gfield_label gform-field-label' for='input_10_82'>If yes, please specify<\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_10_82' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_80\" ><legend class='gfield_label gform-field-label' >Have you used any Retinol\/Retin-A\/Tretinoin\/Accutane\/AHA\u2019s on the area to be waxed in the past week?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_80'>\n\t\t\t<div class='gchoice gchoice_10_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Yes'  id='choice_10_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_80_0' id='label_10_80_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='No'  id='choice_10_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_80_1' id='label_10_80_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_83\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_83\" ><label class='gfield_label gform-field-label' for='input_10_83'>If yes, when and how often?<\/label><div class='ginput_container ginput_container_text'><input name='input_83' id='input_10_83' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_84\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_84\" ><legend class='gfield_label gform-field-label' >Have you used any other skin thinning medications?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_84'>\n\t\t\t<div class='gchoice gchoice_10_84_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='Yes'  id='choice_10_84_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_84_0' id='label_10_84_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_84_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='No'  id='choice_10_84_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_84_1' id='label_10_84_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_85\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_85\" ><label class='gfield_label gform-field-label' for='input_10_85'>If yes, which ones?<\/label><div class='ginput_container ginput_container_text'><input name='input_85' id='input_10_85' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_103\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_103\" ><b>New use of any of the medications listed above increases the possibility of a reaction.<p>\nPlease inform the Esthetician if you have begun taking any new medications since your last session.<\/div><div id=\"field_10_105\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_105\" ><h3 class=\"gsection_title\">Body\/Facial Waxing Disclosure<\/h3><\/div><fieldset id=\"field_10_104\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_104\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Please check to acknowledge each line below<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_10_104'><div class='gchoice gchoice_10_104_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.1' type='checkbox'  value='I understand that the use of any medications increases the possibility of a reaction.'  id='choice_10_104_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_104_1' id='label_10_104_1' class='gform-field-label gform-field-label--type-inline'>I understand that the use of any medications increases the possibility of a reaction.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_104_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.2' type='checkbox'  value='I understand that waxing can have certain side effects such as skin lifting\/removal, redness, scabbing, bruising, scarring, swelling, tenderness, hyperpigmentation, and\/or breakouts.'  id='choice_10_104_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_104_2' id='label_10_104_2' class='gform-field-label gform-field-label--type-inline'>I understand that waxing can have certain side effects such as skin lifting\/removal, redness, scabbing, bruising, scarring, swelling, tenderness, hyperpigmentation, and\/or breakouts.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_104_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.3' type='checkbox'  value='I understand that waxing soft tissue may cause the skin to tear resulting in the need for stitches. The most common occurrence of this is in a Brazilian bikini wax.'  id='choice_10_104_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_104_3' id='label_10_104_3' class='gform-field-label gform-field-label--type-inline'>I understand that waxing soft tissue may cause the skin to tear resulting in the need for stitches. The most common occurrence of this is in a Brazilian bikini wax.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_104_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.4' type='checkbox'  value='I will arrive showered, with hair trimmed 1\/4 to 1\/2 inch (trimming is an additional charge).'  id='choice_10_104_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_104_4' id='label_10_104_4' class='gform-field-label gform-field-label--type-inline'>I will arrive showered, with hair trimmed 1\/4 to 1\/2 inch (trimming is an additional charge).<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_104_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.5' type='checkbox'  value='I have not shaved for three weeks before my wax appointment.'  id='choice_10_104_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_104_5' id='label_10_104_5' class='gform-field-label gform-field-label--type-inline'>I have not shaved for three weeks before my wax appointment.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_104_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.6' type='checkbox'  value='I will refrain from tanning 48 hours before and after my appointment to reduce the risk of hyperpigmentation.'  id='choice_10_104_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_104_6' id='label_10_104_6' class='gform-field-label gform-field-label--type-inline'>I will refrain from tanning 48 hours before and after my appointment to reduce the risk of hyperpigmentation.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_106\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_106\" >I have read the above information and I have addressed any concerns with my Esthetician. I give permission to my practitioner to perform the waxing procedure we have discussed and will hold them 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.<p>\nI have read and understand the post-treatment home care instructions. I am willing to follow the recommendations made by my Esthetician for a home care regimen that can minimize or eliminate possible negative reactions. If I have additional questions or concerns regarding my treatment or suggested home product\/post-treatment care, I will consult my Esthetician immediately.\n<p>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 LaVida Massage or the Esthetician responsible for any of my conditions that were present, but not disclosed at the time of this skincare procedure, which may be affected by the treatment performed today.<\/div><div id=\"field_10_42\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_42\" ><label class='gfield_label gform-field-label' for='input_10_42'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_10_42_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><input type='hidden' class='gform_hidden' name='input_10_42_valid' id='input_10_42_valid' 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