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Sugaring Consent Form

We have the right to refuse services for all sugaring if proper hygiene has not been followed (showered and thoroughly cleansed front to back) or if we feel there is risk of contraindication from information provided written or verbal.

I understand that if I have Herpes or Staph/MRSA, I may experience an outbreak after the sugaring service.

I understand I may carry Herpes and/or Staph/MRSA without any physical symptoms or a medical diagnosis.

I also understand that a sugaring service does not allow the opportunity to contract these conditions from my technician.

I understand all of the above mentioned reactions. I also understand if I change my skincare routine or medications, including OTC meds and vitamins, I must inform the professional PRIOR to any service in the future.

I understand that with all treatments certain risks are involved and that any complications or side effects from known or un-known causes could occur. I freely assume these risks.

I understand that if I cancel or miss my appointment within the 24 hour cancellation policy I will be charged the FULL SERVICE FEE.

If you have any questions regarding your sugaring service please call or text me first. Do not believe everything you read on the internet. Do not ask your friends, they are not professionally licensed, experienced or educated in professional sugaring services.

Post care: nothing that causes you to sweat; no tanning beds; no lakes, pools, spas or saunas; no lotions, creams or serums, and no exfoliation for 24 hours.

Today's Date: August 26, 2019

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

How Did You Hear About Us?
I am 18 years of age or older*
No
Yes
Latex Allergies*
No
Yes
Have you been sugared or waxed before?*
No
Yes
Do you have any tendencies towards
Ingrown hairs
scarring
eczema
Break outs
bruising
psoriasis
Bumps
hyperpigmentation
Have you received a recent chemical exfoliation such as a glycolic peel or other AHA treatment in the last 7 days?*
No
Yes

If yes, when?
Have you applied any topical products containing glycolic, lactic or salicylic acid, lightening or bleaching gels in the last 7 days?*
No
Yes

If yes, when?
Have you had microdermabrasion, laser resurfacing, light therapy or injectable treatments in the last 7 days?*
No
Yes

If yes, when?
Are you taking acne drugs or using exfoliating topical products such as Retin-A® or other Vitamin A products?*
No
Yes

If yes, when?
Have you had continuous exposure to the sun, shaved, scrubbed or experience recent peeling or irritation in the last 48 hours?*
No
Yes

If yes, when?

Skin treatments

Dates

Products currently using on face and neck

Medical Conditions
Herpes virus*
No
Yes
Staph/MRSA*
No
Yes
Allergies*
No
Yes

Medications in the last 8 weeks including OTC drugs & vitamins
Pregnant or lactating?*
No
Yes
Under a dermatologist's care now or recently?*
No
Yes

Name of Doctor

Allergies to products or medications
History of fever blisters or cold sores?*
No
Yes
Tanning regime or use of tanning booths?*
No
Yes

Frequency
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

How Did You Hear About Us?
I am 18 years of age or older*
No
Yes
Latex Allergies*
No
Yes
Have you been sugared or waxed before?*
No
Yes
Do you have any tendencies towards
Ingrown hairs
scarring
eczema
Break outs
bruising
psoriasis
Bumps
hyperpigmentation
Have you received a recent chemical exfoliation such as a glycolic peel or other AHA treatment in the last 7 days?*
No
Yes

If yes, when?
Have you applied any topical products containing glycolic, lactic or salicylic acid, lightening or bleaching gels in the last 7 days?*
No
Yes

If yes, when?
Have you had microdermabrasion, laser resurfacing, light therapy or injectable treatments in the last 7 days?*
No
Yes

If yes, when?
Are you taking acne drugs or using exfoliating topical products such as Retin-A® or other Vitamin A products?*
No
Yes

If yes, when?
Have you had continuous exposure to the sun, shaved, scrubbed or experience recent peeling or irritation in the last 48 hours?*
No
Yes

If yes, when?

Skin treatments

Dates

Products currently using on face and neck

Medical Conditions
Herpes virus*
No
Yes
Staph/MRSA*
No
Yes
Allergies*
No
Yes

Medications in the last 8 weeks including OTC drugs & vitamins
Pregnant or lactating?*
No
Yes
Under a dermatologist's care now or recently?*
No
Yes

Name of Doctor

Allergies to products or medications
History of fever blisters or cold sores?*
No
Yes
Tanning regime or use of tanning booths?*
No
Yes

Frequency
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

How Did You Hear About Us?
I am 18 years of age or older*
No
Yes
Latex Allergies*
No
Yes
Have you been sugared or waxed before?*
No
Yes
Do you have any tendencies towards
Ingrown hairs
scarring
eczema
Break outs
bruising
psoriasis
Bumps
hyperpigmentation
Have you received a recent chemical exfoliation such as a glycolic peel or other AHA treatment in the last 7 days?*
No
Yes

If yes, when?
Have you applied any topical products containing glycolic, lactic or salicylic acid, lightening or bleaching gels in the last 7 days?*
No
Yes

If yes, when?
Have you had microdermabrasion, laser resurfacing, light therapy or injectable treatments in the last 7 days?*
No
Yes

If yes, when?
Are you taking acne drugs or using exfoliating topical products such as Retin-A® or other Vitamin A products?*
No
Yes

If yes, when?
Have you had continuous exposure to the sun, shaved, scrubbed or experience recent peeling or irritation in the last 48 hours?*
No
Yes

If yes, when?

Skin treatments

Dates

Products currently using on face and neck

Medical Conditions
Herpes virus*
No
Yes
Staph/MRSA*
No
Yes
Allergies*
No
Yes

Medications in the last 8 weeks including OTC drugs & vitamins
Pregnant or lactating?*
No
Yes
Under a dermatologist's care now or recently?*
No
Yes

Name of Doctor

Allergies to products or medications
History of fever blisters or cold sores?*
No
Yes
Tanning regime or use of tanning booths?*
No
Yes

Frequency
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

How Did You Hear About Us?
I am 18 years of age or older*
No
Yes
Latex Allergies*
No
Yes
Have you been sugared or waxed before?*
No
Yes
Do you have any tendencies towards
Ingrown hairs
scarring
eczema
Break outs
bruising
psoriasis
Bumps
hyperpigmentation
Have you received a recent chemical exfoliation such as a glycolic peel or other AHA treatment in the last 7 days?*
No
Yes

If yes, when?
Have you applied any topical products containing glycolic, lactic or salicylic acid, lightening or bleaching gels in the last 7 days?*
No
Yes

If yes, when?
Have you had microdermabrasion, laser resurfacing, light therapy or injectable treatments in the last 7 days?*
No
Yes

If yes, when?
Are you taking acne drugs or using exfoliating topical products such as Retin-A® or other Vitamin A products?*
No
Yes

If yes, when?
Have you had continuous exposure to the sun, shaved, scrubbed or experience recent peeling or irritation in the last 48 hours?*
No
Yes

If yes, when?

Skin treatments

Dates

Products currently using on face and neck

Medical Conditions
Herpes virus*
No
Yes
Staph/MRSA*
No
Yes
Allergies*
No
Yes

Medications in the last 8 weeks including OTC drugs & vitamins
Pregnant or lactating?*
No
Yes
Under a dermatologist's care now or recently?*
No
Yes

Name of Doctor

Allergies to products or medications
History of fever blisters or cold sores?*
No
Yes
Tanning regime or use of tanning booths?*
No
Yes

Frequency
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

How Did You Hear About Us?
I am 18 years of age or older*
No
Yes
Latex Allergies*
No
Yes
Have you been sugared or waxed before?*
No
Yes
Do you have any tendencies towards
Ingrown hairs
scarring
eczema
Break outs
bruising
psoriasis
Bumps
hyperpigmentation
Have you received a recent chemical exfoliation such as a glycolic peel or other AHA treatment in the last 7 days?*
No
Yes

If yes, when?
Have you applied any topical products containing glycolic, lactic or salicylic acid, lightening or bleaching gels in the last 7 days?*
No
Yes

If yes, when?
Have you had microdermabrasion, laser resurfacing, light therapy or injectable treatments in the last 7 days?*
No
Yes

If yes, when?
Are you taking acne drugs or using exfoliating topical products such as Retin-A® or other Vitamin A products?*
No
Yes

If yes, when?
Have you had continuous exposure to the sun, shaved, scrubbed or experience recent peeling or irritation in the last 48 hours?*
No
Yes

If yes, when?

Skin treatments

Dates

Products currently using on face and neck

Medical Conditions
Herpes virus*
No
Yes
Staph/MRSA*
No
Yes
Allergies*
No
Yes

Medications in the last 8 weeks including OTC drugs & vitamins
Pregnant or lactating?*
No
Yes
Under a dermatologist's care now or recently?*
No
Yes

Name of Doctor

Allergies to products or medications
History of fever blisters or cold sores?*
No
Yes
Tanning regime or use of tanning booths?*
No
Yes

Frequency
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

How Did You Hear About Us?
I am 18 years of age or older*
No
Yes
Latex Allergies*
No
Yes
Have you been sugared or waxed before?*
No
Yes
Do you have any tendencies towards
Ingrown hairs
scarring
eczema
Break outs
bruising
psoriasis
Bumps
hyperpigmentation
Have you received a recent chemical exfoliation such as a glycolic peel or other AHA treatment in the last 7 days?*
No
Yes

If yes, when?
Have you applied any topical products containing glycolic, lactic or salicylic acid, lightening or bleaching gels in the last 7 days?*
No
Yes

If yes, when?
Have you had microdermabrasion, laser resurfacing, light therapy or injectable treatments in the last 7 days?*
No
Yes

If yes, when?
Are you taking acne drugs or using exfoliating topical products such as Retin-A® or other Vitamin A products?*
No
Yes

If yes, when?
Have you had continuous exposure to the sun, shaved, scrubbed or experience recent peeling or irritation in the last 48 hours?*
No
Yes

If yes, when?

Skin treatments

Dates

Products currently using on face and neck

Medical Conditions
Herpes virus*
No
Yes
Staph/MRSA*
No
Yes
Allergies*
No
Yes

Medications in the last 8 weeks including OTC drugs & vitamins
Pregnant or lactating?*
No
Yes
Under a dermatologist's care now or recently?*
No
Yes

Name of Doctor

Allergies to products or medications
History of fever blisters or cold sores?*
No
Yes
Tanning regime or use of tanning booths?*
No
Yes

Frequency
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

How Did You Hear About Us?
I am 18 years of age or older*
No
Yes
Latex Allergies*
No
Yes
Have you been sugared or waxed before?*
No
Yes
Do you have any tendencies towards
Ingrown hairs
scarring
eczema
Break outs
bruising
psoriasis
Bumps
hyperpigmentation
Have you received a recent chemical exfoliation such as a glycolic peel or other AHA treatment in the last 7 days?*
No
Yes

If yes, when?
Have you applied any topical products containing glycolic, lactic or salicylic acid, lightening or bleaching gels in the last 7 days?*
No
Yes

If yes, when?
Have you had microdermabrasion, laser resurfacing, light therapy or injectable treatments in the last 7 days?*
No
Yes

If yes, when?
Are you taking acne drugs or using exfoliating topical products such as Retin-A® or other Vitamin A products?*
No
Yes

If yes, when?
Have you had continuous exposure to the sun, shaved, scrubbed or experience recent peeling or irritation in the last 48 hours?*
No
Yes

If yes, when?

Skin treatments

Dates

Products currently using on face and neck

Medical Conditions
Herpes virus*
No
Yes
Staph/MRSA*
No
Yes
Allergies*
No
Yes

Medications in the last 8 weeks including OTC drugs & vitamins
Pregnant or lactating?*
No
Yes
Under a dermatologist's care now or recently?*
No
Yes

Name of Doctor

Allergies to products or medications
History of fever blisters or cold sores?*
No
Yes
Tanning regime or use of tanning booths?*
No
Yes

Frequency
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

How Did You Hear About Us?
I am 18 years of age or older*
No
Yes
Latex Allergies*
No
Yes
Have you been sugared or waxed before?*
No
Yes
Do you have any tendencies towards
Ingrown hairs
scarring
eczema
Break outs
bruising
psoriasis
Bumps
hyperpigmentation
Have you received a recent chemical exfoliation such as a glycolic peel or other AHA treatment in the last 7 days?*
No
Yes

If yes, when?
Have you applied any topical products containing glycolic, lactic or salicylic acid, lightening or bleaching gels in the last 7 days?*
No
Yes

If yes, when?
Have you had microdermabrasion, laser resurfacing, light therapy or injectable treatments in the last 7 days?*
No
Yes

If yes, when?
Are you taking acne drugs or using exfoliating topical products such as Retin-A® or other Vitamin A products?*
No
Yes

If yes, when?
Have you had continuous exposure to the sun, shaved, scrubbed or experience recent peeling or irritation in the last 48 hours?*
No
Yes

If yes, when?

Skin treatments

Dates

Products currently using on face and neck

Medical Conditions
Herpes virus*
No
Yes
Staph/MRSA*
No
Yes
Allergies*
No
Yes

Medications in the last 8 weeks including OTC drugs & vitamins
Pregnant or lactating?*
No
Yes
Under a dermatologist's care now or recently?*
No
Yes

Name of Doctor

Allergies to products or medications
History of fever blisters or cold sores?*
No
Yes
Tanning regime or use of tanning booths?*
No
Yes

Frequency
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

How Did You Hear About Us?
I am 18 years of age or older*
No
Yes
Latex Allergies*
No
Yes
Have you been sugared or waxed before?*
No
Yes
Do you have any tendencies towards
Ingrown hairs
scarring
eczema
Break outs
bruising
psoriasis
Bumps
hyperpigmentation
Have you received a recent chemical exfoliation such as a glycolic peel or other AHA treatment in the last 7 days?*
No
Yes

If yes, when?
Have you applied any topical products containing glycolic, lactic or salicylic acid, lightening or bleaching gels in the last 7 days?*
No
Yes

If yes, when?
Have you had microdermabrasion, laser resurfacing, light therapy or injectable treatments in the last 7 days?*
No
Yes

If yes, when?
Are you taking acne drugs or using exfoliating topical products such as Retin-A® or other Vitamin A products?*
No
Yes

If yes, when?
Have you had continuous exposure to the sun, shaved, scrubbed or experience recent peeling or irritation in the last 48 hours?*
No
Yes

If yes, when?

Skin treatments

Dates

Products currently using on face and neck

Medical Conditions
Herpes virus*
No
Yes
Staph/MRSA*
No
Yes
Allergies*
No
Yes

Medications in the last 8 weeks including OTC drugs & vitamins
Pregnant or lactating?*
No
Yes
Under a dermatologist's care now or recently?*
No
Yes

Name of Doctor

Allergies to products or medications
History of fever blisters or cold sores?*
No
Yes
Tanning regime or use of tanning booths?*
No
Yes

Frequency
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

How Did You Hear About Us?
I am 18 years of age or older*
No
Yes
Latex Allergies*
No
Yes
Have you been sugared or waxed before?*
No
Yes
Do you have any tendencies towards
Ingrown hairs
scarring
eczema
Break outs
bruising
psoriasis
Bumps
hyperpigmentation
Have you received a recent chemical exfoliation such as a glycolic peel or other AHA treatment in the last 7 days?*
No
Yes

If yes, when?
Have you applied any topical products containing glycolic, lactic or salicylic acid, lightening or bleaching gels in the last 7 days?*
No
Yes

If yes, when?
Have you had microdermabrasion, laser resurfacing, light therapy or injectable treatments in the last 7 days?*
No
Yes

If yes, when?
Are you taking acne drugs or using exfoliating topical products such as Retin-A® or other Vitamin A products?*
No
Yes

If yes, when?
Have you had continuous exposure to the sun, shaved, scrubbed or experience recent peeling or irritation in the last 48 hours?*
No
Yes

If yes, when?

Skin treatments

Dates

Products currently using on face and neck

Medical Conditions
Herpes virus*
No
Yes
Staph/MRSA*
No
Yes
Allergies*
No
Yes

Medications in the last 8 weeks including OTC drugs & vitamins
Pregnant or lactating?*
No
Yes
Under a dermatologist's care now or recently?*
No
Yes

Name of Doctor

Allergies to products or medications
History of fever blisters or cold sores?*
No
Yes
Tanning regime or use of tanning booths?*
No
Yes

Frequency
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

How Did You Hear About Us?
I am 18 years of age or older*
No
Yes
Latex Allergies*
No
Yes
Have you been sugared or waxed before?*
No
Yes
Do you have any tendencies towards
Ingrown hairs
scarring
eczema
Break outs
bruising
psoriasis
Bumps
hyperpigmentation
Have you received a recent chemical exfoliation such as a glycolic peel or other AHA treatment in the last 7 days?*
No
Yes

If yes, when?
Have you applied any topical products containing glycolic, lactic or salicylic acid, lightening or bleaching gels in the last 7 days?*
No
Yes

If yes, when?
Have you had microdermabrasion, laser resurfacing, light therapy or injectable treatments in the last 7 days?*
No
Yes

If yes, when?
Are you taking acne drugs or using exfoliating topical products such as Retin-A® or other Vitamin A products?*
No
Yes

If yes, when?
Have you had continuous exposure to the sun, shaved, scrubbed or experience recent peeling or irritation in the last 48 hours?*
No
Yes

If yes, when?

Skin treatments

Dates

Products currently using on face and neck

Medical Conditions
Herpes virus*
No
Yes
Staph/MRSA*
No
Yes
Allergies*
No
Yes

Medications in the last 8 weeks including OTC drugs & vitamins
Pregnant or lactating?*
No
Yes
Under a dermatologist's care now or recently?*
No
Yes

Name of Doctor

Allergies to products or medications
History of fever blisters or cold sores?*
No
Yes
Tanning regime or use of tanning booths?*
No
Yes

Frequency
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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