Nailcare Client Consultation Form

NAILCARE CLIENT CONSULTATION FORM
How did you hear about Skintuition?*
If a friend referred you, please share their name
Did you find Tracy from the Meticulous Manicurist Global Network of Certified Nail Technicians?*

YesNo
If you experience "troubled toes and feet", you're welcome to submit photos here before your scheduled appointment. NOT A REQUIREMENT, BUT YOU'RE WELCOME TO IF YOU FEEL IT WILL HELP TRACY.

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Submit Photos if Applicable Cancelof
Do you already have an appointment scheduled?*

Yes, I'm all set!Not yet, please have someone contact me
Name*
Date of Birth*

MonthDayYear
Age*
Email Address*
Phone Number*
Can we communicate with you via text message and/or email?*

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?*
How often do you receive professional nail services?*

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
Do you experience any of the following nail conditions?*

Toenail Fungus (see note below)Impacted or Ingrown ToenailsPincer Nails (nail ends curve inward)Broken ToenailDiscolorationThin, WeakThickSplittingPeelingRidgesHabitual Nail BiterNONE
PLEASE NOTE: IF YOU SCHEDULE FOR A "FIRST TIME FRESH START 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 FRESH START 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 $50 BUT... NO CHANGE IN THE TIME SET ASIDE TO PERFORM YOUR SERVICE.
Do you experience any of the following skin conditions?*

FissuresExcessive Callus BuildupAthlete's Feet (PLEASE TREAT AT LEAST 2 WEEKS LEADING UP TO YOUR SCHEDULED APPOINTMENT)DrynessInflammationHangnailsNONE
Do you experience swelling?*

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
Do you have any of the following health conditions?*

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 VeinsNONE
As noted when booking your appointment, the weight limit for our pedicure chair is 450lbs. Unfortunately, if you exceed this weight, we do not have the facilities to accommodate you and your comfort is our priority.*

I understand
What medications are you currently taking and their purpose?*
If NONE, please enter NONE in the box
Do you have allergies to:*

NO KNOWN ALLERGIESLATEXArtificial FragranceFruitsTree Nuts
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
How dedicated to your at home nailcare routine are you?*

Very dedicatedSomewhat dedicatedIt's not that important to me
If you are a "restorative" pedicure client, before and after progress photos will be taken. Do we have your permission to share your photos on social media platforms or discuss with "The Meticulous Manicurist", Lori Halloway?*

YesNoUnsure
Policies to Keep Business Running Smoothly
PLEASE COME TO YOUR APPOINTMENT WITHOUT POLISH TO ENSURE EVERY VALUABLE MINUTE IS DEDICATED TO DETAILED NAIL WORK.
I acknowledge that with any optional nailcare 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 Skintuition Holistic Skincare immediately.

I understand that if I purchase a package of services or products, 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 72 HRS PRIOR TO YOUR SCHEDULED APPOINTMENT.

IF YOU NEED TO CANCEL WITHIN THE 72 HR TIME-FRAME, YOU WILL NEED TO CONTACT US AT (703) 653-0567 IMMEDIATELY SO WE CAN CANCEL YOUR APPOINTMENT AND YOU WILL BE CHARGED A NON-REFUNDABLE FEE OF $75 PER SCHEDULED SERVICE.

SAME DAY CANCELLATIONS AND NO SHOWS WILL BE CHARGED THE FULL AMOUNT OF SCHEDULED SERVICES.

DEPOSIT - Restorative or Fresh Start Pedicure

New Client Pedicure Deposit$50.00

If you are a NEW CLIENT and scheduled for a PEDICURE, we require a NON-REFUNDABLE, $50 DEPOSIT to be paid within 24 hrs to secure your appointment. Your deposit will be deducted at checkout after your service.

Total $0.00

Credit Card

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

Credit Card