Skip to content
Click here for Nurturing Your Nature gift cards!
Home
Our Team
Clinic and Spa
FAQs
Contact
Blog
Philosophy
Testimonials
Gallery
Menu
Home
Our Team
Clinic and Spa
FAQs
Contact
Blog
Philosophy
Testimonials
Gallery
Body Sugaring Intake
Download Our Post Care Advice
Contact Information:
First Name
Last Name
Date of Birth
Address
City
Zip Code
Email
Home Phone
Cell Phone
How did you find out about us?
How did you hear about Alexandria Professional and sugaring?
Medical Information:
What is your present method of hair removal?
Have you ever experienced the Alexandria Professional Treatment before?
Yes
No
Do you have any known allergies?
Yes
No
Are you allergic to latex?
Yes
No
Have you ever experienced a severe skin reaction, i.e. hives?
Yes
No
If YES, give details
Do you suffer from eczema or psoriasis?
Yes
No
Do you use Retin-A, Retinol or Glycolic Acid in any skin treatment or do you receive any professional skin treatments?
Yes
No
Do you use micro-dermabrasion?
Yes
No
Do you consider your skin to be sensitive?
Yes
No
If YES, please explain
When was your last sugar or wax session on this area?
Authorization
Protecting Your Personal Information,
we recognize and respect every individual’s right to privacy. The above infor- mation will be held in the strictest confidence and is used to provide your Alexandria Professional Practitioner with in- formation needed to carry out the best possible treatment for you individually.
PLEASE BE ADVISED THAT:
Every client is provided with a Client Information Brochure as well as professional advice from the CERTIFIED ALEXAN- DRIA PROFESSIONAL PRACTITIONER carrying out the treatment. If these instructions are followed closely, clients should experience a safe and pleasurable experience.
Alexandria Professional and Nurturing Your Nature are not responsible for reactions caused by other products used by the client and for reactions caused as a result of the information above not being correct.
Signature:
Today's date"
Submit Now