Intake Form

To help us get to know you please fill out the information below. We look forward to working with you!

Name *
Name
Phone
Phone
Birthday
Birthday
Medical Conditions
(Check all that apply)
Date of last chemical peel
Date of last chemical peel
Are you pregnant?
*THE INFORMATION THAT I’VE PROVIDED IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. I WILL INFORM MY THERAPIST IF ANY OF MY INFORMATION CHANGES IN FUTURE VISITS TO LOVE SUGARING HAIR REMOVAL. I UNDERSTAND THAT REACTIONS MAY OCCUR WHEN RECEIVING ANY TREATMENT FROM ANY SERVICE PROVIDER. I RELEASE LOVE SUGARING HAIR REMOVAL AND ALL CONTRACTED EMPLOYEES FROM ANY LIABILITY IF ANYTHING SHOULD HAPPEN WHILE VISITING THE ESTABLISHMENT, OR POST REACTIONS FOLLOWING MY VISIT.*