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FFBC Body Waxing/Sugaring Intake

Client Information

First name*

Last name*

Email*

Phone

Which of the following services have you had done in the PAST?*

Waxing

Sugaring

Laser Hair Removal

Electrolysis

None

How did that experience go?

Services to be Provided

Please select one or both:*

Body Waxing

Body Sugaring

Health History

Do you use Retin-A, Renova, or Retinol/Vitamin A derivative products for the body?*

Yes

Sometimes

Have you used any alpha-hydroxy acid or glycolic acid products in the area you intend to have serviced in last 48 hours?*

Yes

Unsure

Are you currently taking Accutane or have you taken it in the past?*

Yes

If yes, how long?

Are you on any other medication?*

Yes

Please list all current or recent medications:

Are you exposed to the sun on a daily/regular basis or do you use a tanning bed?*

Yes

If you are healing from sunburn in the area you intend to have services please let us know.

If yes, how often and when was the last time?

Do you have any topical allergies that you're aware of?*

Yes

List of known allergies:

Do you have any existing skin conditions or concerns?*

Yes

If yes, please describe:

Lifestyle

Do you:*

use saunas

exercise

sweat excessively

have oily skin

have ingrowns

have body acne

have thick course hair

other

If other, please mention anything you feel is appropriate:

Is skincare important to you?*

Absolutely

Sometimes

Not really

Do you have any piercings or healing tattoos in the area to be serviced?*

Yes

If yes, please describe:

Service Understanding and Consent

I request and consent to the application of waxing and/or sugaring treatments to my body by the trained technicians/Estheticians of Fearless Femme Beauty Company.

I understand that waxing and sugaring involve the application of a sticky substance to the skin to remove unwanted hair and that there are inherent risks, including but not limited to skin irritation, allergic reactions, and discomfort.

I am aware that while waxing and sugaring are generally safe, there is a risk of side effects such as redness, swelling, bumps, bruising, or ingrown hairs.

I understand that certain medications and products, such as Retin-A, Accutane, antibiotics or other skin-thinning agents can increase the risk of adverse reactions

I acknowledge that exfoliation and moisturizing may help reduce the risk of ingrown hairs and other post-treatment issues.

I acknowledge that rare side effects may occur, and I agree to consult a physician if any adverse reactions persist.

I agree to follow any aftercare instructions provided by Fearless Femme Beauty Company to ensure optimal results and minimize potential risks.

I consent to the use of photographs or videos taken during my service for promotional purposes, understanding that my identity will remain confidential unless otherwise agreed upon.

By checking this box, I agree to the terms above.

Client Acknowledgement

I have provided accurate and complete information regarding my health, allergies, medications, and skin conditions. I understand that withholding information may result in adverse reactions.
I agree to inform my esthetician of any changes to my health status or skin conditions prior to each service.
I understand that Fearless Femme Beauty Company reserves the right to refuse service to anyone exhibiting contraindications or not adhering to health and safety protocols.

By checking this box, I agree to the terms above.

Liability Waiver

By signing this document, I acknowledge the inherent risks and voluntarily assume full responsibility for any injury, damage, or loss that may result from my participation. I hereby waive and release the business, its owners, and its staff from any and all liability, past, present, and future, relating to the services provided.

Signature*

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Date*

Month

Day

Year

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301.264.6069

1197 N. East Street Frederick, MD 21701