Nail Technician Client Consultation Form

Client's Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Occupation

Select an appointment below

Services you would like

Current Health Conditions: (Please select below)

Do you have any allergies?

Please list below the type of allergies that you have

Have you undergo any surgical procedure?

Please list the name of the procedure and the reason

Are you currently taking any medications?

Please list them below including vitamins and supplements

What are your hobbies?

Are you wearing gloves if you clean the house, do the gardening, or washing dishes?

How do you take care of your hands?

How do you take care of your feet?

Are you currently using or applying products to your nails? If yes, please list the name of the products below

When is the last time you had a professional nail service?

How often do you go to a nail salon?

Nail condition

Cuticle condition

Do you have any cuts or wounds in your hands or feet?

Are you preparing for a special occasion?

Would you like to receive promotions and offers via email?

By signing below, I confirmed that all information I entered in this form is accurate and true. I also authorized this Nail Technician to perform nail care service to my hands and feet.

Client Signature

Date Signed

Date