Client Intake Form

Get ready for your appointment with Hilary Humphrey!

First Name *

Last Name *

Phone *

Email *

Address *

City *

State *

Postal code *

Date of birth *

+ Let me know who, so I can send them some love! 🤍 *

+ Please elaborate, so we can track our marketing efforts! *

+ What's your Instagram handle? *

Feel free to add any other social platforms, we love to stay connected!

Emergency Contact Name: *

Emergency Contact Phone Number: *

How would you describe your hair growth? *

Fast

Slow

Not Sure

Fast hair growth may result in less time needed between maintenance appointments.

Do you exercise regularly? *

If so, please elaborate - helps us understand your aftercare needs 🤍

Are you pregnant? *Hormonal changes result in changes to hair growth patterns. If you're pregnant, we like to make sure we have the treatment room set up for your comfort 🤍

* Are you currently using any topical creams or medications that might affect your skin's sensitivity? *

Yes

List all current medications, herbal supplements, and vitamins: *

This helps us understand your aftercare needs 🤍

* Do you have any known allergies to sugar, lemon, or natural ingredients used in sugaring? *

Yes

Are you prone to ingrown hairs? *

Yes

Do you exfoliate regularly? *

Yes

Have you ever had a Sugaring or Waxing Service? *

Yes

Neither

Which service and how long ago? *

* Have you experienced any skin sensitivity or reactions to waxing or sugaring in the past? Please explain: *

Terms & Conditions

Please read and acknowledge the following to indicate that you have read and understood the terms and conditions.

Sugaring Home Care *

I understand I need to exfoliate the area to be treated within 24 hours before service to remove dead skin cells and help prevent ingrown hairs.

I confirm that I have disclosed any conditions such as eczema, psoriasis, or other skin conditions that may affect the sugaring process.

I understand that sugaring may cause temporary redness, irritation, or ingrown hairs, and I accept these potential outcomes.

I understand the recommended aftercare instructions for sugaring services to minimize irritation and ensure the best results. (garnetlash.com/sugaring)

Late & Cancellation Fees *

I understand that rescheduling or cancellation requires a 24 hour notice to avoid a 50% service charge.

I understand that no shows are charged 100%.

If you are not here 20 minutes past your scheduled appointment time, you will be considered a no show.

I authorize Hilary Humphrey to perform the services I have specified that I am here for. I understand that it is my responsibility to be still during the process until otherwise advised. I have been fully informed as to the methods and procedures concerning the services. The risks of the cosmetic service/procedure I have chosen have been disclosed to me. Some cases may result in complications, such as transient skin irritation or allergic reaction to any other products used. If at any time I feel uncomfortable with the procedure, I will inform the stylist who will gladly rectify the problem, including ending the session if I (or the stylist) wish. It has been represented to me that no guarantees, warranties, promises, commitments or other statements as to the results of this service have been made. I acknowledge that I have received no particular representations or guarantees, and I am consenting to the procedure at my own risk. I have revealed or disclosed on the form above, all conditions and circumstances regarding my health and health history, medications being taken and any past reactions to products used or medications taken. Additional conditions could occur or be discovered during or after the procedure, which could affect my ability to tolerate the procedure.

I release, give up, acquit and discharge Hilary Humphrey and/or anyone affiliated including any partnership, corporations or company associated with said individual from any claims or damages of any nature. I agree to pay any costs of legal services necessary to further effector confirm said release. I further agree that this release shall be in contemplation of any possible damages, either known or unknown at the signing of this waiver and release form, and said damages are specifically waived following the signing of this waiver and release form. I further agree that in the event any litigation ensues, it shall be placed before the American Arbitration Association for resolution. I agree that in the event a decision is determined in favor of one party over the other, the prevailing party shall be entitled to reasonable attorney fees and costs as set by the arbitrator. I further agree to hold Hilary Humphrey nameless and harmless from any and all damages. I release Hilary Humphrey from any responsibility for pre-existing conditions I have not revealed, or any consequential change to those conditions that arises subsequent to the procedure. I understand that I am responsible for any medical treatment I may need to receive as a result of getting this procedure. I accept full responsibility for these and any other complications, which may arise or result during or following the eyelash extension service(s), which are to be performed at my request.

I certify that I have read and fully understand the above waiver and release form. I certify that I have consulted with Hilary Humphrey and have had all of my questions answered. I accept the explanation of potential complications and risks described herein. I certify I am of sound mind, and I am fully capable of executing this Waiver & Release form for myself. I acknowledge and fully understand that there might be other unknown risks not reasonably foreseeable at this time.

Effective January 1, 2022 all credit card payments will include a 4% service charge. Cash or other electronic payments are welcomed.

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