Waxing & Sugaring

Name

First NameLast Name

Email

example@example.com

Phone Number

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

Date of Birthday

Hair removal methods utilized recently and in the past?

Have you taken Retin-A, Renova, Accutane, or any other acne medicine in the last year? If yes, when did it happen?

Do you use any other skin-thinning products or blood-thinning medications?

Do you regularly use tanning beds and/or expose yourself to the sun?

Have you had cancer treatment? If so, when and which therapies were used?

Are there any open skin lesions on your body?

Do you suffer from any allergies? If yes, please provide a list.

Are ingrown hairs a problem for you?

How did you hear about Lia Beauty Suite?

Please be aware that waxing/sugaring might cause redness, swelling, soreness, and other unpleasant side effects. By signing this form, I acknowledge that I have read the preceding material and have answered the questions truthfully. I give permission to undertake the waxing/sugaring technique we discussed and I agree to not hold the esthetician and Lia Beauty Suite responsible against any liability that may arise as a result of this procedure. I agree to follow all post-waxing/sugaring safety precautions, including no peels, tanning, exfoliation, or wet room services; no swimming, spas, or hot tubs for at least 72 hours; and any home skin care procedures as indicated by my service provider. I understand that the Lia Beauty Suite will take all reasonable steps to minimize or eliminate any undesirable reactions.

Signature

Date