I have read the above information and if I have any concerns, I will address to my sugar technician. I give permission to my sugar technician, Jennifer McLean and/or Jackie Hinckley, to perform the sugaring procedure we have discussed and will hold her harmless from any liability that may result from this treatment. I have given an accurate account of the questions asked above, including all known diseases, allergies, prescription drugs, or products I am currently ingesting or using topically. I understand my sugar technician will take every precaution to minimize or eliminate negative reactions as much as possible.
I agree that this constitutes full disclosure, and that supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any question answered. I understand the procedure and accept the risks. I do not hold the sugar technician, Jennifer McLean and/or Jackie Hinckley, whose signature is below, responsible for any of my conditions that were present, but not disclosed at the time of this sugaring procedure, which may be affected by the treatment performed today.