Sugaring Intake Form

Name

Date of Birth (Must be 18 or older to book, if underage parent/guardian must be present at the time of service)

Appointment Date

Have you ever been sugared or waxed before?

Has it been at least 2 weeks since you last shaved ? Or 3-4 weeks since your last shave/sugar?

Have you used any Alpha Hydroxy Acid (AHA) or Glycolic products in the past 48-72

Are you using Retin-a, Renova, of Accutane (an oral form of Retin-a)?*

Do you suffer from any medical problems? Ex: diabetes, high blood pressure?

If you answered yes above please explain

How did you hear about us

I understand there are certain contraindications that would preclude me from receiving sugaring hair removal, such as uncontrolled diabetes, melanoma, open wounds, varicose veins, and sunburn. I understand that if I have any concerns, I will address these with my esthetician. 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.

Signature