Glam Body Sugaring Boutique Sugaring Consent Form

Glam Body Sugaring Boutique Sugaring Consent Form
Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number
E-mail
Date of Birth

Month Day Year Date Picker Icon
What body part are you sugaring today?
When did you last shave?
When was your last menstrual cycle?
Because of water retention and for you personal comfort, we advise to avoid hair removal two days before your cycle starts and two days after. If you must have your sugaring done during these times, we offer numbing gel (bikini area) to take the edge off.
DO YOU HAVE OR ARE YOU PRONE TO?

Ingrown Hairs Scarring Bumps Hyperpigmentation Bruising
Do you have allergies? If yes, list them here:
Are you diabetic?
Have you ever been treated for cancer?
Have you used any of the following in the last 48-72 hours?

Accutane Retin-A Alpha Hydroxy Acid Glycolic Acid Resorcinol Scrub or Peel Tazorac Triluma Renova Adalapene DIFFERIN Alustra Avage Hydroquinone Proactiv Lactic acid
Have you used other skin thinning medication? If so, which?
Do you use a tanning bed?
Other illness/condition a medical professional is presently treating you for?
NEW USE OF ANY MEDICATIONS YOU HAVE LISTED ABOVE INCREASES THE POSSIBILITY OF A REACTION. PLEASE INFORM YOUR ESTHETICIAN IF YOU HAVE BEGUN TAKING NEW MEDICATIONS SINCE YOUR LAST SESSION.

*Please note sugaring does have certian side effects such as redness, bruising, swelling, tenderness, hyperpigmention and/or pimples.

I have read the above information and if i have any concerns, I have addressed them with my esthetician, I give permission to my esthetician to perform the sugaring/ and or lightening treatment we have discussed and will hold her harmeless from any liabilty that may result from this treatment.

I have given an accurate account of the questions asked above including all known allergies or 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. I have read and understand the post treatment home care instructions. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have any additional questions or concerns regarding my treatment or suggested home products/post treatment care, I will consult my esthetician immediatelty. I acknowledge my esthetician fully disclosed post op care such as NO swimming pools, saunas, jacuzzi's, exercising or sexual intercourse for a full 24 hours after treatment.

I agree that this constitutes full dosclousure, and that it supercedes any previous verbal or written disclosures. I certify that I have read and fully understand the above paragraph and that I have had sufficient opportunity for discusiion to have any questions answered. I undestand the procedure and accept the risks. I do not hold the esthetician responsible for any of my conditions that were present but not disclosed at the time of this skin care procedure, whcih may be affected by the treatment performed today.
CANCELLATION/ NO SHOW/ LATE ARRIVAL POLICY

We understand that unplanned issues can come up and you may need to cancel an appointment. If that happens, we respectfully ask for scheduled appointments to be cancelled at least 48 hoiurs in advance. Our staff wants to be available for your needs and the needs of all of our clients. When a client does not show up for a scheduled appointment, another client loses an opportunity to be seen and the Esthetician loses the opportunity to make income.

Although we have always had a cancellation policy, circumstamnces have called for us to enforce a policy for charging for no show appointments and those appoiintments not cancelled 48 hours before your scheduled appointment.

We do thank you for being a valued client, and for your understanding and cooperation.

As of September 1, 2015 the folowing fees will be implemented:

You may cancel your appointment without charge up to 48 hours before your scheduled appointment.

Same day Cancellations will be charged 50% of the scheduled service price.

No call or No Show will be charged 100% of scheduled service price.

Thank you for taking the time to complete this form. Please sign below.
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