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.
NAILCARE CLIENT CONSULTATION FORM
"SOAK-OFF GEL POLISH" MUST BE REMOVED PRIOR TO YOUR APPOINTMENT DUE TO SCHEDULING CONSTRAINTS.

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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
Name *
Date of Birth *

Month Day Year
Age *
Email Address *
Phone Number *
Can I 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 *
Lifestyle
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.
Hand and Foot Health
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.
Health History
Do you have any of the following health conditions? *

Anemia Arthritis, Tendinitis, Bursitis Autoimmune Disease Circulatory Problems Cancer Cold Hands or Feet Dermatitis Diabetes (Type 1 or 2) Excema Fibromyalgia Fungal Infection Heart Problems Hepatitis High or Low Blood Pressure HIV/AIDS Kidney Problems Lymphedema Osteoporosis Pregnancy Scoliosis Stroke Thyroidism (Hypo or Hyper) Tuberculosis Varicose Veins NONE
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.
Your Current Nailcare Routine
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
Policies to Keep Business Running Smoothly
I acknowledge that with any optional nail service certain risks are involved and that complications from known or unknown causes could occur. If I am receiving elective nail services at Skintuition Holistic Skincare and I experience any unusual side effects, I will contact Tracy Childs 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, TEXT (703) 864-7939 and I will handle it for you
- $75 NON-REFUNDABLE FEE charged for LAST MINUTE CANCELLATIONS WITHIN 48 HRS of scheduled appointment and NO SHOWS
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