Hair Removal Waiver

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Hair Removal Waiver

Please complete prior to your sugaring/hair removal appointment. This is only required once a year or if the answers to any questions change.

Please type your first and last name *

When is your birthday? *

YYYY

What is a good phone number for you? *

What is your email? *

Have you ever received a wax or sugaring before? *

Yes

Have you taken Accutane in the past 6 months? *

Yes

If yes to the previous question, have you gotten clearance from your doctor to receive a sugaring service?

Yes

N/A

Clear selection

Are you using Differin, Retin-A, Renova, or any other retinoids? *

Yes

Do you take any blood thinners or medications that make you photosensitive? *

Yes

If yes to the previous question, list medications

Are you currently sunburned? *

Yes

Are you currently nursing or pregnant? *

Yes

Please select all that apply *

HIV/AIDS

Eczema

Diabetes

Herpes of any kind

Hepatitis

Psoriasis

Cancer

Other (please specify)

None of the above

Required

Anything else for me to know, concerns, things to make you more comfortable, etc.

How did you find Simply Sugared Aesthetics (Google Ad, referral, etc)?

I understand that the sugar mixture contains sugar, lemon, and water. I have advised my technician of any allergies and understand there may be reactions of the skin after the service. I agree to release all liability associated with my service from my technician and Simply Sugared Aesthetics, LLC. I agree to follow all pre and post care instructions. I understand and assume all risks of the service I am receiving. *

I agree

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This content is neither created nor endorsed by Google.