Sugar Coated YEG

Name

First NameLast Name

Preferred Pronoun(s)

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Birth Date

Date

How did you come to hear about Sugar Coated YEG?

Did a Friend Refer you? if so who?

What form of hair removal do you currently use?

Do you suffer from any medical conditions? i.e diabetes, high blood pressure if yes please explain

Do you suffer from any lung disorders such as Asthma? If yes please explain

Do you have any known allergies? i.e – Shellfish, Latex, Nuts, etc, if yes please explain

Have you ever experienced a severe skin reaction i.e hives? If yes please explain

Do you have any skin disorders? i.e Eczema or psoriasis? if yes please explain

Are you taking any medication either orally or topically? if yes please explain

Do you use Accutane, Retina-A, Retinol, Glycolic Acid in any skin treatment or do you receive any professional (dermatology) skin treatments? if yes explain and state when last used

Do you consider your skin sensitive?

YesNo

If yes to above which products are you currently using?

Are you currently Pregnant or Breastfeeding?, If YES for how far along?

Are you experiencing any hormone imbalances? If yes please explain

Do you consent to before and after photos taken and used for the Sugar Coated YEG social media platforms (photos are discrete and will not state who it is unless client would like)

AUTHORIZATION;

Protecting your personal information, I recognize and respect every individuals right to privacy. The above information will be held in the strictest confidence and is used only to provide you with the best treatment possible for you individually.

PLEASE BE ADVISED THAT;

All pre and post care information is listed on www.sugarcoatedyeg.com under the About Tab. I will remind you of this prior to your appointment as well as during. In order to have the best results it is recommended that you follow the pre and post care information. Sugar Coated YEG is not personally responsible for any medical/personal/financial complications as a result of a treatment/product. Also it is a clients responsibility to notify if any information on this form should change in any way to continue providing the best service.

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