Nailcare Client Consultation Form

Skintuition Holistic Skincare uses disposable items when possible and high level sterilization (Wayne S500 dry heat cabinet and Rejuvenate AHP Advanced Hydrogen Peroxide) for implements, EXCEEDING STATE REQUIRMENTS.

"GEL POLISH" NOT APPLIED AT SKINTUITION MUST BE REMOVED PRIOR TO YOUR APPOINTMENT DUE TO SCHEDULING CONSTRAINTS OR A REMOVAL APPOINTMENT SHOULD BE SCHEDULED.

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DISCONTINUE HAIR REMOVAL (SHAVING, LASER TREATMENTS, DEPILATORIES, ETC.) 24 HOURS PRIOR TO PEDICURES.

How did you hear about Skintuition? *

If a friend referred you, please share their name

Do you already have an appointment scheduled? *

Yes, I'm all set! Not yet, please have someone contact me

If you haven't opted in for TEXT MESSAGE APPOINTMENT REMINDERS, do we have your permission to do so? *

Yes No

Name *

Date of Birth *

Month Day Year

Age *

Email Address *

Phone Number *

Can we communicate with you via text message and/or email? *

Yes No

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Emergency Contact *

Relationship *

Emergency Contact Phone Number *

What is your occupation? *

What are some things you like to do in your spare time? *

Are you wearing gloves if you clean the house, garden, wash dishes, etc? *

Yes No Sometimes

How often do you receive professional nail services? *

Weekly Every 2 Weeks Monthly Quarterly Special Occasions Never

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.

Do you experience any of the following nail conditions? *

Break Easily Discoloration Habitual Nail Biter Peeling Ridges Splitting Thickness Weakness None

Do you experience any of the following cuticle conditions? *

Dryness Inflammed Hangnails Torn None

Do you experience any of the following conditions on your hands? *

Age Spots Dry Irritated Sensitive Warts None

Do you have any pain in your hands? If so, please explain.

Do you experience swelling? *

Ankles Feet Legs None

Do you have any pain in your feet? If so, please explain.

Do you have excessive calluses? If treating them at home, please explain how.

Do you have any of the following health conditions? *

What medications are you currently taking and their purpose? *

If NONE, please enter NONE in the box

Do you have allergies to: *

NO KNOWN ALLERGIES Artificial Fragrance Fruits Tree Nuts

Please explain what happens when you are exposed to what you are allergic to, if applicable.

Are you currently applying products to your nails? If yes, please list. *

If NONE, please enter NONE in the box

How dedicated to your at home nailcare routine are you? *

Very dedicated Somewhat dedicated It's not that important to me

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

ONLINE CANCELLATIONS accepted up to 72 hrs BEFORE YOUR SCHEDULED APPOINTMENT
APPOINTMENT CHANGES OR CANCELLATIONS WITHIN 72 hrs of your scheduled appointment, CALL or TEXT (703) 653-0567 and we will handle it for you
$75 NON-REFUNDABLE FEE charged for LAST MINUTE CANCELLATIONS WITHIN 48 HRS of scheduled appointment and NO SHOWS

COVID-19 LIABILITY WAIVER

Due to the 2019-2021 outbreak of the novel Coronavirus (COVID-19), Skintuition Holistic Skincare is taking extra precautions with the care of every client to include health history review and enhanced sanitation/disinfection procedures in accordance with the Virginia Department of Professional and Occupational Regulation guidance.

Symptoms of COVID-19 include:

Fever
Fatique
Dry Cough
Difficulty Breathing

I agree to the following:

I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above WITHIN THE LAST 14 DAYS.

I affirm that I, as well as all household members, have not been diagnosed with COVID-19 WITHIN THE PAST 30 DAYS.

I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 WITHIN THE PAST 30 DAYS.

I affirm that I, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 DAYS.

I understand that Tracy Childs, Skintuition, LLC, and employees cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.

Skintuition Holistic Skincare is following these enhanced procedures to prevent the spread of COVID-19:

Skintuition Holistic Skincare is by-appointment-only, private spa and services are rendered to one client at a time.

You are required to wear a mask or face covering while inside Skintuition Holistic Skincare but allowed to remove during services where it interferes with your service
Each client required to wash hands or use the sanitation station upon arrival and before leaving
Social distancing is adhered to with the exception of receiving services due to close contact being necessary to provide esthetic and nail services
Additional time included between appointments to minimize client contact with eachother
Your service provider will wear a face covering during all services
Your service provider will maintain clean hands and wear nitrile gloves during all services
All product bottles used during treatment will be placed on the trolley for disinfection and disposable items will be used when possible
All surfaces will be wiped thoroughly with hospital grade disinfectant before and after each client according to the manufacturer's directions
Contactless checkout if clients prefer but the checkout area is wiped down after each guest interaction

By signing below, I agree to each statement above and release Tracy Childs and Skintuition, LLC from any and all liability for the unintentional exposure or harm due to COVID-19.

Tracy Childs and all employees agree to abide by these standards and affirms the same.

I acknowledge and accept Skintuition Holistic Skincare policies and COVID-19 precautions as stated above *

Clear

NAILCARE CLIENT CONSULTATION FORM

Lifestyle

Hand and Foot Health

Health History

Your Current Nailcare Routine

Policies to Keep Business Running Smoothly