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Sugar Me Suite
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Sugar Hair Removal
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Before Your Appointment
After Your Appointment
Student Model Registration
Sign In
My Account
Welcome
About
Sugar Me Suite
Our Sugaristas
Work with SMS
Services
Sugar Hair Removal
EpilFree
Skincare Therapies
Men's Services
FAQ
Payment Options
Before Your Appointment
After Your Appointment
Student Model Registration
Certification
NEW FACIAL CLIENT FORM
PERSONAL INFORMATION
Name
*
First Name
Last Name
Birthdate
MM
DD
YYYY
How did you hear about Sugar Me Suite
Google
Facebook
Instagram
Yelp
Referral
Car Magnet
If you were referred, please state his/her name
Please check any conditions that you are currently experiencing today.
*
Headache
Inflammation
Muscle cramps
Anxiety
Fatigue
Insomnia
Stress
Forgetfulness
None
Please check which aroma(s) you prefer
*
Lavender
Citrus
Geranium
Peppermint
Lemongrass
Patchouli
Eucalyptus
Frankincense
Other
ESTHETICS INFORMATION
What kind of skin do you have?
*
Normal
Oily
Dry
Combination
What area(s) or concern do you have regarding your skin?
*
Breakouts / Acne
Blackheads / Whiteheads
Uneven skin tone
Sun damage
Excessive oil / Shine
Wrinkles / Fine lines
Dull / Dry skin
Rosacea
Broken capillaries
Redness / Ruddiness
Dehydrated
Sun, Liver, Brown Spots
Other
Have you ever had an allergic reaction to any of the following?
*
Cosmetics
Medicine
Food
Animals
Sunscreen
Drugs
Iodine
Pollen
AHAs
Fragrance
Shellfish
Latex
Other
If you have been under the care of a dermatologist within the past year, please explain
Do you currently use or have you used in the last three (3) months Retin-a, Renova, AHAs, or Retinol/Vitamin A derivative products?
*
Yes
No
Have you received Botox, Restylane, or Collagen injections in the last six (6) months?
*
Yes
No
I have completed this form to the best of my ability and knowledge and agree to inform the technician on any changes in the above information. I have been informed and understand the contraindications to the requested treatments and agree that I do not have any condition(s) that would make the requested treatments unsuitable. I will inform the technician of any discomfort I may experience at any time during my treatment to allow them to adjust accordingly. I agree to waive all liabilities towards my technician and the employer for any injury or damages incurred due to any misrepresentation of my health history.
*
I agree
Thank you!
