NEW SUGARING CLIENT FORM

Name

First Name

Last Name

Birthdate

YYYY

How did you hear about Sugar Me Suite

If you were referred, please state his/her name

What method of hair removal do you currently use?

Have you used any Alpha Hydroxy Acid (AHA) or Glycolic products in the last 72 hours?

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

Are you exposed to the sun on a daily basis or are you considering spending more time in the sun soon?

Are you pregnant?

Are you currently on your menstrual cycle?

Are you allergic to latex?

Please list any known allergies

Please list any adverse reactions to any skincare products you have had.

Please list any medical problems.

Please list any medications you are currently taking.

I give permission to my therapist to perform the sugaring procedure we have discussed. I will hold her, her staff or Tamara's Professional Body Sugaring harmless from any liability 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 as much as possible

I agree

NEW SUGARING CLIENT FORM

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