Client Consultation Form

Client's Name*

First NameLast Name

Phone No*

Email*

Date of birth*

DD-MM-YYYY

Address

Street Address

Street Address Line 2

Post Code

Select an appointment below

Services you would like*

Current Health Conditions: (Please select below)*

Do you have any allergies?*

YesNo

Please list below the type of allergies that you have

Are you currently taking any medications?*

YesNo

Please list them below including vitamins and supplements

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

YesNo

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*

SplitPeelCrackGood

Cuticle condition*

DryTornInflamedNormal

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

YesNo

Are you preparing for a special occasion?*

YesNo

NOTES or Anything else I should to be aware of

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

I agree for any photos taken during and after the treatment to be used for marketing purposes.

Client Signature*

Date Signed*

Date