Consultation form

1
Name* This field is required.
Title
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Address* This field is required.
Street Address
Street Address Line 2
town
county
Postal Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Mobile Number* This field is required.
5
Date of Birth* This field is required.
Day
Month
Year
6
Occupation* This field is required.
7
Health Historyplease select all conditions that apply to you
diabetes
varicose veins
skin disease
hypertension
fungal infection
bone problems
pregnancy
cardiovascular disease
hepatitis A
hepatitis B
HIV
rheumatic fever
other
8
Please list any medication
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Small
Ok
Ok
9
Do you have any allergies* This field is required.
YESNO
10
please list any allergies here
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Small
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Ok
11
Have you recently had any surgery or due any?* This field is required.please list details below
12
Patch Tests

Patch tests are needed for:-

Hd Brows

Lvl Lashes

Lash extensions

Tinting

Brow lamination

St Tropez tans

Patch tests need to be booked in 48 hrs prior to you treatment at Tip2Toe and noted on your client forms and kept upto date every 6 months. We cannot accept patch tests that were preformed from other salons.

We cannot carry out the above treatments without having a patch test.
13
do you require nail services?
YESNO
14
do you require LvL Lash services?* This field is required.
YESNO
15
Do you require Lash extensions?* This field is required.
YESNO
16
Do you require Waxing * This field is required.
YESNO
17
Do you require Brow lamination* This field is required.
YESNO
18
do you require Hd Brow services?* This field is required.
YESNO
19
do you require St Tropez spray tanning?* This field is required.
YESNO
20
what type of nail services have you had before?* This field is required.
21
what nail care do you regularly use at home?* This field is required.
22
do you wear gloves to clean the house, wash the dishes or do the gardening?* This field is required.
YESNO
23
how often do you visit nail salons* This field is required.
24
when is the last time you had a nail treatment and please describe* This field is required.
25
describe your nail condition* This field is required.tick all that applies
generally good
brittle
oily
sensitive
weak
strong
dry
26
Cuticle condition* This field is required.please tick all the applies
dry
inflammed
normal
over grown
27
Todays Date* This field is required.
Date
Year
Month
Day
28
Nail treatment consent* This field is required.* I confirmed that all information I entered in this form is accurate and true. *i will update my records should anything change to my medical history *I authorised this Nail Technician to perform nail care service to my hands and feet. NAIL ENHANCEMENTS *i acknowledge that these nail enhancements should be rebalanced every 3/4 weeks or professionally removed. *these enhancements are not guaranteed and are my sole responsibility once i leave the salon. *any breakages or repairs must be paid for. * i will read and understand the Aftercare leaflet given to me and realise that i am responsible for the general care of my nails. sign below..
29
please indicate if you have (or have had) any of the following* This field is required.
allergies
hormone/imbalances
alopecia/hair loss
hypersensitive skin
blepharitis
lice
cataracts
menopause
conjuctivitis
psoriasis
contagious disease
recent beauty treatment
diabetic retinopathy
rosacea
dry eye syndrome
sensitive eyes
eczema
seizures
eye infection cyst/ stye
skin or eyelids
glaucoma
trichotillomania
hay fever
hives
weak/brittle lashes
None
30
if the answer is yes to any of the consultation questions, please provide details
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do you wear contact lenses* This field is required.
YESNO
32
have you received lash services before* This field is required.
YESNO
33
Todays Date* This field is required.
Date
Year
Month
Day
34
LvL Lash treatment consent* This field is required.i herby authorise the fully trained and certified Nouveau Lashes technician to perform upon myself the Nouveau Lashes treatment. I understand that it is not the responsibility of the technician to diagnose a clients susceptibility to allergies. I accept full responsibility for determining the treatment outcome(which may include decisions regarding the degree of lash curl, length and colour). This has been agreed during the course of the consultation. I will read and understand the Aftercare leaflet given to me and realise that i am responsible for the general care of the lashes. sign below..
35
Please indicate if any of the following applies in order to help your lash technician give and effective and safe treatment....
are you taking medication?
are you receiving any treatment fro you GP?
Do you have any allergies?
Are you pregnant or breast feeding?
DO you suffer from epilepsy or any form of seizures
Have you had any recent surgery to the eye area?
36
Do you suffer from any of the following?
i do you suffer from any of the following?
Conjunctivitis/Sties?
Dry eye syndrome?
Dermatitis
Blepharitis
Psoriasis
Eczema
Cataract
Glucoma
Claistronphobia
Hayfever
37
Todays Date* This field is required.
Date
Year
Month
Day
38
Lash Extension Consent* This field is required.The data captured on this record card is to ensure we can safely perform treatments on you and contact you should we need to regarding your appointments. sign below
39
Have you had Brazillian/ hollywood waxing before?* This field is required.
YESNO
40
are you currently using, or have in the past, any of the following...
Retin-A, Renova or Accutane (an oral form of Retin-A)
Skin thinning products and/or drugs i.e. anti aging face cream
sunbeds
41
Are you diabetic* This field is required.
YESNO
42
Are you currently taking medications?(including over the counter drugs/herbal supplements)* This field is required.
YESNO
43
Have you had any recent surgeries?* This field is required.
YESNO
44
Please list any other illness/condition you are currently being treated for by the medical professional
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Ok
45
Todays Date* This field is required.
Date
Year
Month
Day
46
Client waxing consent* This field is required.I have read all and filled in as my of the information regarding the waxing procedures. i will address these with my waxing therapist . i give permission to my waxpert therapist to perform the waxing procedure we have discussed and will hold her harmless for any liability that may result from the treatment. I have given an accurate account of the questions asked including all known allergies or prescription drugs or products i am currently ingesting or using topically. i understand that my waxpert therapist will take every precaution to minimise or eliminate negative reactions as much as possible. Waxing. does have certain side effects such as redness, bruising, tenderness, etc.; although this is rare. I have read and understand the post treatment and will use the homecare advise and instructions. I am willing to follow recommendations made for a homecare regime that can minimise or eliminate possible negative reactions. In the event that i may have additional questions or concerns regarding my treatment or aftercare, i will consult my waxpet therapist immediately. I agree that this constitutes full disclosure, and that supersedes any previous verbal or written disclosures. I certify that i have read and fully understand that above paragraph and that i have had. sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the waxpert therapist, responsible for any of my condition that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed.
47
Tick if you suffer from any of the following
eczema
psoriasis
sunburn
haemophilia
conjunctivitis
stye
skin cancer
recent scar tissue
moles
cold sores
Diabetes
Allergies
un-controlled epilepsy
blood/circulatory disorder
blood bon e viruses
contact lenses must be removed
48
Are you pregnant or breast feeding* This field is required.
YESNO
49
Are you taking any medication which could affect the treatment (blood thinners, Roaccutane etc) please detail below
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Ok
50
Do you have any allergies e.g aromatherapy, nut, etc? * This field is required.
YESNO
51
Todays Date* This field is required.
Date
Year
Month
Day
52
Brow Lamination Consent* This field is required.I understand the patch test does not guarantee that an allergic reaction will not occur. I understand that tinting has some inherent risk of irritation to the eye area, including the eye itself and could result in stinging or burning, blurry vision and potentially blindness should the product enter the eye. I understand that if the products accidentally meet the eye, my eye will be flushed with water and medical attention may be required. I understand that there may be staining left on the skin after tinting process. This will fade and go away within a shirt time. I understand there may be swelling or irritation in waxed area and this my only be temporary condition. I understand that, while every attempt will be made to provide me with my chosen colour, everyones hair absorbs colour differently and results may not be the colour i initially wanted. I confirm that i give my consent to carry out Brow Lamination treatment we have discussed. The information given is correct and to the best if my knowledge. i will follow the verbal and written aftercare advice given to me.
53
Do any of the following apply to you?if you tick to any boxes the treatment may not be suitable for you at this time
recent skin infection around the eyes
eye infection
recent surgical procedure around the eye or brow area
54
Have you had/used any of the following within the last 6 weeks?* This field is required.*if you wish to have your treatment and use fake tan, we strongly recommend that you apply a barrier on an around your brows when applying tan. this will help to avoid your eyebrows tint turning a green shade.
fake tan*
anti-ageing creams
botox or fillers
facial peels, facial or AHAs
steroid creams or tablets
sun beds
antihistamine
None
55
do you suffer from any of the following skin conditions around your eyebrow area?* This field is required.
eczema
sensitive skin
psoriasis
None
56
Have you suffered from or received treatment for any of the following conditions?
acne
Allergies
Chemotherapy or radiotherapy
diabetes
alopecia
trichotillomania
57
Are you currently taking any medication or undergoing medical treatment?* This field is required.if you answer yes please discuss with your stylist.
YESNO
58
have you had any of the following treatments before?
hd brows
hd brow sculpt
another brow lamination
other brow treatment (please specify in the next box)
59
List all other brow treatments below
60
have you ever had any previous reactions to HD Brows or other eyebrow treatments?* This field is required.If you answer yes please describe in the next box. your stylist will discuss with you and adjust your treatment where necessary.
YESNO
61
have you ever had any previous reactions to henna, tints, dyes or lightening products?* This field is required.If you answer yes your stylist may not use tint or lightening paste.
YESNO
62
are you (or could you be) pregnant, breastfeeding or undergoing IVF?* This field is required.If you answer yes your stylist may not use tint or lightening paste.
YESNO
63
is there any other information we should be aware of that may affect your suitability for treatment?
64
Although your treatment will be carried out to the highest standards, complications can still occur. possible side affects include :-

* Allergies or reaction to any products, ingrediaents or diplation technique involved in the treatment.

* Small spots and bumps

*skin grazing

*soreness, redness or itching

*Sensitivity to waxing
65
Todays Date* This field is required.
Date
Year
Month
Day
66
Hd Brows Treatment Consent* This field is required.*i acknowledge the possible side affects and any risks that my medical history has highlighted and i agree to go ahead with the treatment. * i have carried out all necessary patch tests 48 hours before the date of my appointment *i have read and understand all information provided above and within my patch test. *i have been offered a wax sensitivity test 48 hors before my treatment(not compulsory) *i am satisfied with the explanation of the treatment and aftercare from my stylist. *i have answered the questions regarding my medical history truthfully and to the best of my knowledge. * i agree to contact my stylist immediately in the event of the adverse effects. *i herby authorise the fully trained and certified HD Brow stylist to perform my chosen HD Brow treatment upon myself. sign below...
67
Have you used tanning products before?* This field is required.
YESNO
68
What shade of tan are you hoping achieve* This field is required.
light sunkissed
golden tan
deep dark tan
69
how much time do you have for your tan to develop* This field is required.
1 - 3 hours
4 -8 hours
70
How would you describe your skin type* This field is required.
Dry
Normal
Oily
sensitive
71
Do you have any of the following
allergies
hypersensitive skin
skin disorders
72
have you had any recent wounds, tattoos, piecing or surgery?* This field is required.
YESNO
73
are you taking any medication or are you under a doctors care?* This field is required.
YESNO
74
do you suffer from any respiratory problems?* This field is required.
YESNO
75
are you pregnant or breast feeding or undergoing IVF?* This field is required.
YESNO
76
Have you undergone hair removal in the last 24hrs?* This field is required.
YESNO
77
do you have bleached hair or eyebrows?* This field is required.
YESNO
78
have you used St Tropez Tan Enhancing polish?* This field is required.
YESNO
79
Please indicate areas that you do not wish to tan or require more attention.
80
Have you any queries from this advice form or any questions?
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Ok
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Type a question* This field is required.
i am over 16 years old
i am aged 16 or under and have proof of parental consent
82
Todays Date* This field is required.
Date
Year
Month
Day
83
St Tropez treatment consent* This field is required.We strongly recommend that our customers participate in skin sensitivity test at least 24hrs prior to the full application of any product to reduce the risk of adverse reaction , even if previously used and also update your patch test every 6 months. However you are responsible for your own safety and it is your decision as to whether you wish to participate in a patch test or not. please sign the consultation form to confirm you understand this. sign below...
84
BOOKING CONDITIONS

Cancellations, Non-Refundable Booking Fees and No-Shows

In order to book your appointment, we will require your card details for either a deposit or a non-refundable booking fee to be taken at the time of booking. Card details are securely held by our booking system (stripe) and are not viewable by the salon.

Deposits are transferable and refundable when given 24hrs notice from the time of you appointment.
Where your card details are captured for booking fees, your card will not be charged at the time of booking, however it will be charged in the event of a no-show or late cancellation/alteration. Cancellations/alterations within 24 hours of your appointment start time will be charged at 50% of the total appointment cost or no-shows will be charged at 100% of the total appointment cost.
Appointment reminders will be sent 36 hours before your appointment so please contact us as early as possible to avoid your card being charged.
We reserve the right to ask for payment in full before a booking will be made. If this is done, this amount will be treated the same as a non-refundable booking fee and will be retained in proportion to the above late cancellation charges (50% for cancellations within 24hrs and 100% for no show appointments).
If no booking fee or card capture is taken and you cancel within 24 hours, we reserve the right to ask for a late cancellation charge of 50% (or 100% if you no show) of the total appointment cost, then payment in full in advance, to book any future appointments.
If you do not show for your appointment and haven’t contacted the salon, you may be removed from the online booking system. Please contact us to book a new appointment, we will require payment in full, in advance of any new appointment.
85
Would you like to hear about promotions and offers via email/sms?* This field is required.
YESNO
86
Do you consent to any photos/videos of your treatment(s) being used on our social media?* This field is required.
YESNO
87
Todays Date* This field is required.
Date
Year
Month
Day
88
Client Card Consent* This field is required.*By signing below, I confirmed that all information I entered in this form is accurate and true. *I authorise the Beauty therapists/Nail Technician to perform a service around all the information ive supplied and will update them if anything changes. *I also consent for my personal data to be stored in compliance with GDPR regulations. The date will not be shared with any 3rd party. * I have read and understand the booking conditions of tip2toe salon. sign below
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