Carly Turner Nails & Beauty Consultation Form

Address and Contact Details.

Carly Turner Nails & Beauty is situated within Nikki's Hair and Beauty Salon, 95 Comberton Hill, Kidderminster, Worcestershire, DY10 1QH. 01562 748161/07523 853053. carlyturnernailsandbeauty@outlook.com Facebook/Instagram @carlyturnernailsandbeauty @nikkishairandbeautysalon
Beauty Consultation Form.

Carly Turner Nails & Beauty.
Welcome

Please fill in all information below. Due to insurance regulations I am required for all clients to now complete a Consulatation Form. Without completion of this form I will not be able to carry out any treatments. Carly Turner of Carly Turner Nails and Beauty is a Freelance Beauty Therapist of Nikki's Hair and Beauty Salon.
Name*

First NameLast Name
Date of Birth

DayMonthYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email
example@example.com
Medical History
Are you taking any prescribed medication? (This includes any contraception)*

YesNo
If you answered yes to the question above please tell us the medication you are taking and what it is used for.
Do you have or suffer from any of the following?*

ArthritisEpilepsyDiabetesAsthmaHigh Blood PressureLow Blood PressureCancerBack ProblemsPsoriasisHeart ConditionsThyroidEczemaHIVHepatitisPacemakerOtherNone of the Above
If you answered yes to any of the above please provide us with any information you think will be relevant.
Have you had any recent surgery? (within the last 6 months) if so what was it for and the date you had it. *
Do you have any known allergies?*
Have you had any of the following in the last 6 months?*

BotoxFillerRetin A TreatmentsOtherNone of the Above
If you answered yes to any of the above please could you provide the date you last had the treatment.
If you have any other medical conditions please tell us below.
Are you currently pregnant?*

YesNo
Have you given birth in the last six months?*

YesNo
Are you currently breastfeeding?*

YesNo
COVID-19
Have you experienced COVID-19?*

YesNo
Have you experienced any COVID-19 symptoms in the past month?*

YesNoOther
If you have been infected with the Covid-19 virus please do not visit us until all symptoms have gone. This is usually 14 days after a positive test. If anyone is self isolating in your household please do not visit the salon until there isolation is over. If you contract the virus and have already visited the salon please contact us straight away. Please also do not visit if you have been outside of the country and not self isolated for 14 days prior. If you have contracted Covid-19 and are now clear please inform me as this may affect some treatments you are able to have. (You may need another patch test etc.)*

I understand
Feeling Unwell
If you wake up on the day of your appointment feeling unwell with any of the following symptoms please do not attend your appointment: High Temperature, Cough, Cold, Sore Throat, Loss of Taste, Loss of Smell, Fatigue. No charge will be made if you have to cancel your appointment, but please let us know at the earliest convienience.*

I understand
Completed Patch Tests
Please indicate below if you have received any of the following patch tests. All patch tests have to be carried out every 6 months. The patch test results and date on which they were carried out will be recorded under the clients notes section on the salon booking system Fresha where all members of staff/freelancers from the business Nikki's Hair and Beauty Salon will be able to access this information in order for them to book appointments correctly. This information will also be recorded on Samsung Notes & Sumissions of this form will be available on Jot form, where this form was created. Both of these apps belong to Carly Turner, of Carly Turner Nails & Beauty, and are both secure and password protected apps.Please note if you have suffered from Covid-19 you will be required to have another patch test even if you have recently had one, due to reactions occurring after contracting it.*

Eyelash/Eyebrow TintHenna BrowsEyelash Lift & TintEyelash ExtensionsOtherI don't currently have Eye/Brow TreatmentsI have recently had Covid-19.
Cancellation and Non Refundable Booking Fee Policy
Appointments cancelled within 24 hours will incur a 50% charge of the total treatment amount. "No Shows" or cancelling just before your appointment will incur the full treatment amount. A Non-Refundable Booking Fee will be taken on all bookings over 3 hours long and on all treatments throughout December. This fee will be half of your total treatment amount. Non-Refundable Booking Fees can be made in salon, over the phone or through bank transfer. Your appointment will be held for 24 hours if the fee is not made within this time the appointment will be released. All of above is down to Carly's discretion.*

I understand
Pre-Treatment Advice
All Pre-Treatment advice is given verbally before every new treatment. If you would prefer a Pre-Treatment Advice leaflet emailed to you then please indicate below. You can also find this information on our Facebook or Instagram pages. Please feel free to ring the salon if you have any questions prior to your appointment.

I would like a Pre-Treatment Advice LeafletI do not require a Pre-Treatment Advice leaflet & understand this advice will be given to me verbally before any new appointment
After Care Advice
All aftercare advice is given verbally after every treatment. If you would prefer an aftercare leaflet emailed to you then please indicate below. You can also find this information on our Facebook or Instagram pages. Please feel free to ring the salon if you have any questions prior to your appointment.*

I would prefer an Aftercare LeafletI do not require an Aftercare Leaflet and understand Aftercare advice will be given to me verbally after my appointments.
Data Protection, GDPR and Agreements
I can confirm that I understand how you use and store my data and I give my permission to the businesses Carly Turner Nails & Beauty & Nikki's Hair & Beauty Salon to collect, handle and store my personal data for treatment and appointment purposes in accordance with GDPR Guidelines as of the 25th May 2018. For more information on our salon policies please visit www.nikkishairsalonandbeautybar.co.uk where further details on our privacy policy and Data Protection Agreements can be found.*

I understand
I understand that notes from every appointment along with my Jot form submissions pdfs will be recorded on Samsung Notes a secure and password protected app. These notes will include your full name, dates and details of the treatments that are performed by Carly Turner Nails & Beauty. They will need to be signed by yourself after every treatment, to confirm that what has been written is correct at the time of writing them. These notes are required for insurance purposes. (For example what colour spray tan you had last time you visited or your favourite gel polish colour) Patch Test information from Jot form submissions will also be recorded, as well as any changes to your health, medication or information. All notes will be written and only seen by Carly Turner, of Carly Turner Nails & Beauty. You can ask to see these notes at any time.*

I understand
I understand that once this form has been submitted it will be stored on Jot Form, under submissions. Only Carly Turner from Carly Turner Nails & Beauty will be able to access these submissions.*

I understand
I understand that if at any point during my visit an indicent occurs or I feel unwell I must notify my therapist Carly or another member of staff.*

I understand
I understand that I am responsible to notify this business Carly Turner Nails & Beauty if any of the above information changes.*

I understand
I agree that you can contact me with newsletters, special offers and appointment reminders via text messages and or email, from the businesses Carly Turner Nails and Beauty and or Nikki's Hair and Beauty Salon.*

YesNo
I agree that you can share and use any photographs taken of my treatments on your social media platforms. (For example Nail Treatments, Lash and Brow Treatments)*

YesNo
I can confirm that the information provided above is accurate and true to the best of my knowledge, and I will not hold the salon or Carly Turner of Carly Turner Nails & Beauty, responsible for any damages caused by having supplied incorrect information.*

I confirm
Can we please ask how you heard about us? All information will be confidential and used to help future promotions etc.
Signature*
Print Full Name*
Today's Date*

DayMonthYear
Date
Thank you for taking the time to fill in this Beauty Consultation Form. We look forward to seeing you soon.

Carly Turner Nails & Beauty.
Should be Empty:

Address and Contact Details.

Beauty Consultation Form.

Welcome

Medical History

COVID-19

Feeling Unwell

Completed Patch Tests

Cancellation and Non Refundable Booking Fee Policy

Pre-Treatment Advice

After Care Advice

Data Protection, GDPR and Agreements