Sugaring Consent Form

Client Name (Printed)*

Please be aware of the following information and possible risks:*

I understand there are certain contraindications that would preclude me from receiving sugaring hair removal, such as uncontrolled diabetes, melanoma, open wounds, varicose veins, use of certain products/medications and sunburn.I understand that the use of (AHA) alpha hydroxy or glycolic acids, Retin-a, Renova, or Accutane within 72 hours of epilation is contraindicated and may cause the skin to lift or peel.I understand that the use of tanning beds and/or sun exposure as well as the use of pools, hot tubs or submersion in standing water immediately after sugaring hair removal is contraindicated. Your hair follicles remain open for 24-48 hours and you may be at risk for an infection if post care is not followed.I understand that sugaring may result in bruising, ingrown hairs, and skin irritation, redness or inflammation.I have cited all conditions and circumstances regarding my health history, medications being taken, and any past reactions to products or medications.I understand that sugaring hair removal may permanently damage hair follicles, resulting in permanent hair loss.

Please list any allergies:*

Please list any oral/topical medications, vitamins or supplements:*

Please list any products you are currently using on/near the treatment area such as AHAs, BHAs, etc.*

Before/After photographs are needed for all client charts. I consent to “before-and-after” photographs for the purpose of documentation, potential advertising, and promotional purposes.*

Yes, you may use my photos.Yes, but only for my treatment record.

If I have any concerns, I will address these with my skin care specialist. I give permission to my skin care specialist to perform the sugaring hair removal procedure we have discussed, and will hold him/her and his/her staff harmless and nameless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription drugs, conditions, or products I am currently ingesting or using topically. I understand my skin care specialist 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 skin care specialist immediately.

Client Name (Signature)*

Date*

Date

Informed Consent: Sugaring Hair Removal