Nailcare Client Consultation Form

NAILCARE CLIENT CONSULTATION FORM
How did you hear about Skintuition Holistic Skincare?
If a friend referred you, please share their name
YesNo
Yes, I'm all set!Not yet, please have someone contact me
YesNo, this is my permanent home
Name
Date of Birth (Month/Day/Year)
Age
Email Address
Phone Number
YesNo
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Relationship
Emergency Contact Phone Number
Lifestyle
What is your occupation?
What are some things you like to do in your spare time?
WeeklyEvery 2 WeeksMonthlyQuarterlySpecial OccasionsNever
When is the last time you had a professional nail service?
Have you ever had an unpleasant experience at a nail salon or spa? Please share if you like.
What is your favorite part of having a professional nail service?
Hand and Foot Health
Toenail Fungus (see note below)Impacted or Ingrown ToenailsPincer Nails (nail ends curve inward)Broken ToenailDiscolorationThin, WeakThickSplittingPeelingRidgesHabitual Nail BiterNONEOther
PLEASE NOTE: IF YOU SCHEDULE FOR A "HEALTHY FEET" PEDICURE AND HAVE NAIL FUNGUS, IT'S POSSIBLE YOU MAY ACTUALLY BE A "RESTORATIVE" CLIENT. IN SOME CASES HOWEVER, THE FUNGAL SITUATION IS MILD AND THE "HEALTHY FEET" PEDICURE IS THE CORRECT CHOICE. THIS WILL BE DISCUSSED AT YOUR INITIAL APPOINTMENT IN CASE YOUR APPOINTMENT TYPE NEEDS TO BE ADJUSTED. THERE IS A PRICE DIFFERENCE OF $30 BUT... NO CHANGE IN THE TIME SET ASIDE TO PERFORM YOUR SERVICE.
FissuresExcessive Callus BuildupAthlete's Feet (PLEASE TREAT AT LEAST 2 WEEKS LEADING UP TO YOUR SCHEDULED APPOINTMENT WITH OTC OR RX MEDICATION)DrynessInflammationHangnailsNONE
AnklesFeetLegsNONE
Do you have any pain in your feet? If so, please explain.
Do you have excessive callus buildup? If treating at home, please explain how.
Health History
AnemiaArthritis, Tendinitis, BursitisAutoimmune DiseaseCirculatory ProblemsCancerCold Hands or FeetDermatitisDiabetes (Type 1 or 2)ExcemaFibromyalgiaFungal Nail InfectionHeart ProblemsHepatitisHigh or Low Blood PressureHIV/AIDSKidney ProblemsLymphedemaOsteoporosisPregnancyScoliosisStrokeThyroidism (Hypo or Hyper)TuberculosisVaricose VeinsNONEOther
What medications are you currently taking and their purpose?
If NONE, please enter NONE in the box
NO KNOWN ALLERGIESLATEXArtificial FragranceFruitsTree NutsOther
Please explain what happens when you are exposed to what you are allergic to, if applicable.
Your Current Nailcare Routine
Are you currently applying products to your nails and/or feet? If yes, please list.
If NONE, please enter NONE in the box
Very dedicatedSomewhat dedicatedIt's not that important to me
YesNoUnsure
Policies to Keep Business Running Smoothly
I acknowledge that with any optional personal care service, certain risks are involved and that complications from known or unknown causes could occur. If I am receiving elective spa services and I experience any unusual side effects, I will contact Tracy immediately.

I understand that if I purchase a service or product, individual results vary and I will not be given a monetary refund if I am unsatisfied. I will be offered a credit to use toward other services or products within a reasonable amount of time if proper notification is given.

CANCELLATION POLICY

CANCELLATIONS WILL BE ACCEPTED ONLINE 48 HRS PRIOR
TO YOUR SCHEDULED APPOINTMENT.

IF YOU NEED TO CANCEL WITHIN THE 48 HR TIME-FRAME, PLEASE CONTACT TRACY AT (703) 864-7939 AS SOON AS POSSIBLE. YOU WILL BE CHARGED A NON-REFUNDABLE FEE OF $50 FOR NON-EMERGENCY SITUATIONS.
I acknowledge and accept Skintuition Holistic Skincare policies as stated above*

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NAILCARE CLIENT CONSULTATION FORM

Lifestyle

Hand and Foot Health

Health History

Your Current Nailcare Routine

Policies to Keep Business Running Smoothly