Return Client Informed Consent

Informed Consent - Return Client

The Sugar Coated Sugar and Skin ™
Date of Appointment

MonthDayYear
Please select which service(s) you will be receiving:
Name

First NameLast Name
Phone Number
Please your preferred phone number.Format: (000) 000-0000.
Email
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About You
Have you had any recent changes in your health, supplements, medications, and/or topical skin care products?
If yes, please describe
Lash & Brow Enhancements

Some information about you, and some information about the service(s)
Although every precaution will be made to ensure your safety and well-being before, during and after your tinting application, please be aware of the possible risks below. Please indicate that you understand:
Lash lift aftercare. Following the correct home aftercare after your lash lifting service is essential to attaining optimal results. Please indicate that you understand:
Waxing and/or Sugaring Hair Removal
Have you used any Alpha Hydroxy Acid (AHA), glycolic, and/or salicylic products in the past 48-72 hours?
Are you currently using or have you used within the past year: Retin-a, Renova or isotretinoin (Accutane) an oral form of Retin-a?
Are you using any other skin thinning products and/or drugs?
I understand that waxing does have certain side effects such as skin removal, redness, swelling, tenderness, etc.
Please be aware of the following information and possible risks:
Post-Treatment Home Care - Waxing and/or Sugaring:
To ensure maximum comfort and benefit after the treatment, it is important to follow the steps below at home. I acknowledge that I am advised to:
Facial Treatment

Some information about your skin
Have you had any facial surgical procedures, piercings, tattoos, permanent cosmetic procedures, or other chemical peels within the past year?
If yes, please elaborate:
Have you had any recent radioactive or chemotherapy treatments, sunburns, windburns, or broken skin?
Have you recently waxed or used a depilatory (eg: Nair) on the area to be treated?
Are you currently pregnant or breastfeeding?
Dermaplane, Acne Treatment, and/or Chemical Peel

Some information about you, and some information about the treatments
Although every precaution will be taken to ensure your safety and well-being before, during, and after your chemical peel treatment, please be aware of the following information and possible risks and indicate that you fully understand what to expect. Please indicate:

Although it is impossible to list every potential risk and complication, I understand that recognized contraindications include: Active acne, Active infection of any type, such as herpes simplex or flat warts, Any raised lesions, Any recent chemical peel procedure, Chemotherapy or radiation, Eczema or dermatitis, Family history of hypertrophic scarring or keloid formation, Hemophilia, Hormonal therapy that produces thick pigmentation, Moles, Oral blood thinner medications, Pregnancy, Recent use of topical agents such as salicylic acids, glycolic acids, alpha-hydroxy acids and Retin-A, Rosacea, Scleroderma, Skin Cancer, Sunburn, Tattoos, Telangiectasia/erythema may be worsened or brought out by exfoliation, Thick, dark facial hair, Uncontrolled diabetes, Use of Accutane within the last year, Vascular lesionsI understand that there are risks and complications associated with having a chemical peel and that, very rarely, permanent damage occurs. I understand that my skin therapist will take every precaution to minimize or eliminate negative reactions. I acknowledge that I have been informed of the possible negative reactions (ie: intense erythema, blisters, sores, welts, scabs, or other reactions), and the expected sequence of the healing process (ie: dryness, irritation, redness, and/or peeling of the skin).I understand that this chemical procedure is expected to make the skin feel uncomfortable while being applied but agree to inform the skin therapist immediately if I have questions, concerns, or am overly uncomfortable during treatment or after I return home. In the event that I may have additional questions or concerns regarding my treatment or the suggested home product/post-treatment care, I will consult my skin therapist immediately. I understand that if I choose to consult a physician, that I do so at my own expense.I understand and agree to follow the home-care instructions and recommendations provided by my skin therapist. I understand that I will be responsible for following home regimens that can minimize or eliminate possible negative reactions, including recognizing the importance of adhering to a sunscreen, avoiding the sun/tanning booths, avoiding extreme weather conditions, avoiding excessive exercise, and using a moisturizer specifically recommended to me by my skin therapist. I realize and accept that the consequences of failure to adhere to these instructions may yield undesirable results.
To ensure maximum comfort and benefit after the treatment, it is important to follow the steps below at home:. I acknowledge that I am advised to:
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Cancellation Policy
Reservation & Cancellation Policy for all current and future appointments: a valid credit card is required for all appointments. Please do not forget to confirm your appointment when you receive your reminder. In the event of cancellations received less than 24 hours prior to appointment a cancellation fee of 50% of the reserved service booking will incur. No Shows will be charged 100% (Except in cases of contagious illness as described below.)
If you, or another person in your household, has an infectious or contagious illness, please contact us as soon as possible to reschedule your appointment for a later date. There is no penalty or time-frame required in this case, for your safety and that of other clients.
COVID-19 Information

COVID-19 is a highly contagious virus that spreads from person to person. In addition to long-held and explicit sanitation measures this business has always adhered to, new preventative measures have been put in place to further reduce the spread of this novel coronavirus. However, these best practices still offer no guarantee regarding your potential risk of being infected.
Have you had a fever in the last 24 hours of 100°F or above?
Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath?
Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus-type symptoms?
I understand that, because esthetics involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner/business from any claims related thereto. I give my consent to receive treatment from this practitioner.
I have read the above information. If I have any concerns, I will address these with my skin care therapist. I give permission to my therapist to perform the procedure(s) we have discussed, and will hold him/her and his/her staff harmless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, 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. In the event I may have additional questions or concerns regarding my treatment, 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 on the date of service.

I understand that no specific guarantees of the results can or have been made and that there is the possibility I may require additional treatments/procedures to obtain the expected results at an additional cost. I have read and understand all pre-treatment, post-treatment, and home care instructions. I understand the importance of following all instructions given to me. In the event that I have additional questions or concerns regarding my treatment or post-treatment care, I will consult the technician/esthetician immediately. I understand that if I choose to consult a physician, I do so at my own expense.
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Please upload a well-lit photo of the left side of your face
The Sugar Coated Sugar and Skin™ is located at:

358 Holladay Ct.
Loveland, CO 80537

Feel free to park in front of the third stall in the driveway or in the center parking.

Text or DM me when you get there, and I'll let you know when you can come inside!
Please park in front of the third stall in the driveway or in the center parking.
Client Name

First NameLast Name
Guardian Name if Client Under 18

First NameLast Name
Client Signature (Guardian Signature if Client under 18)
Today's Date

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Informed Consent - Return Client

About You

Lash & Brow Enhancements

Waxing and/or Sugaring Hair Removal

Facial Treatment

Dermaplane, Acne Treatment, and/or Chemical Peel

Feedback

Cancellation Policy

COVID-19 Information