Name

First Name Last Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Emergency Contact Person Name

First Name Last Name

Emergency Contact Person Phone Number

Please enter a valid phone number.

Emergency Contact Person Email

example@example.com

Have you ever had your hair sugared or waxed by a professional?

Yes No

Have you ever had a problem with sugaring or waxing? (e.g. allergic reaction)

Yes No

In the last 48 hours, have you had a peel, microdermabrasion, or tanned?

Yes No

What is your skin type?

Oily Dry Combination Sensitive

Do you have a problem with ingrown hairs?

Yes No

Do you have any allergies?

Yes No

Please list all your allergies/allergens.

Are you on any medications right now? If yes, please specify.

Are you allergic to, or have you ever been allergic to, the following:

Have you eaten any of these foods in the recent 24 hours? If so, check all that apply.

If any of the factors listed above are present, you may suffer higher discomfort as well as an increased risk of side effects such as skin damage, bruising, scabbing, or other complications. If any of the above items change between visits, you must notify your practitioner promptly. For your safety during hair removal or other services, keep your intake information up to date.

When was the last time you shaved or waxed?

Date

Please choose the sugaring service you want:

I understand that if I start or continue to use any of the products indicated above without informing the esthetician prior to current or future treatments, I assume full responsibility for any negative responses. I'm aware that the operation may result in redness, lumps, pain, or irritation.

Signature

Clear

Date

If necessary:

Parent/ Guardian Signature

Clear

Date

Sugaring Consultation Form