Sugaring Consent Form

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Sugar Coochies LLC

Email *

Last Name, First Name *

Phone Number (###) ###-#### *

Street Address *

City, State, Zip Code *

Referred By *

Have you had sugaring or waxing done before? *

Yes

Have you ever had a reaction to waxing/sugaring before? YES or NO- If YES, please describe. *

Do you have any tendencies to: *

Ingrown hairs

Scarring

Bumps

Hyperpigmentation (discoloration)

Bruising

None of the Above

Required

Are you allergic to anything? YES or NO. If YES please list all known allergies. *

Have you received Botox treatments in the last 72 hours? *

Yes

Have you been or will you be in the sun and/or tanning bed within 24 hours of this treatment? *

Yes

Are you using or taking: *

Accutane or Tetracycline

Retinoids such as Retin-A, Renova or Diferin

AHA/Alpha-Hydroxy Acid

BHA/Beta-Hydroxy Acid

Glycolic Acid

NONE OF THE ABOVE

Please list any other medications you are currently taking, if any. *

Are you currently pregnant? *

Yes

Do you have Diabetes, Phlebitis or any skin irritations? *

Yes

Do you consent to before/after photos? (absolutely NO identifying features such as face, tattoos, or birth marks will be shown) *

Yes

By checking each field you agree to the following statements: *

I am at least 18 years of age (or 14 or older with parental consent).

I have read and agree to all salon policies, including late cancellations and arrivals.

I understand that this procedure requires hair being removed from the follicle.

I understand that it is my responsibility to keep my body still and follow the esthetician's guidance.

I understand that some risks of this procedure may be, but not limited to redness and irritation.

I agree to disclose any allergies that I may have.

I understand that I am required to follow the estheticians aftercare instructions.

I agree to wait a minimum of 24 hours before exfoliating.

I agree that by reading and signing this consent form I release the technician and Sugar Coochies from any claims or damages of any nature.

I agree that I read and fully understand this entire consent form.

Required

I have read and understand terms and conditions: *

I have been advised the service(s) provided to me by this salon could have unfavorable results including, but not limited to: allergic reaction, irritation, burning, redness, soreness, etc. I am aware that certain medications and over the counter products can significantly increase the risk of injury when combined with skin care services. I understand that the esthetician & Sugar Coochies does not recommend skin care services for customers using Retin-A, Acutane and products containing alpha hydroxyl, or any other skin thinning treatments. I hereby confirm that I am not using any medications that may cause or contribute to such injury/reaction, and I will advise my esthetician should I use any such medications in the future. I understand there are often inherent risks associated with skin care services, and I agree that as a condition of providing these services on an on going basis, I will not hold Sugar Coochies nor the esthetician, liable.

Required

Due to Covid-19, waiting area space is limited. When arriving, please remain in your vehicle and text 469-862-8186 to let your esthetician know you have arrived. *

I Agree

Required

Electronic Signature Agreement. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide the esthetician & Sugar Coochies or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and the esthetician & Sugar Coochies. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement. You further agree that each use of your E-Signature in obtaining a service constitutes your agreement to be bound by the terms and conditions of the form. *

"I Agree"

Required

Date *

YYYY

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