Client Consultation Form

Client's Name

First NameLast Name

Date of Birth

Date

Email

example@example.com

Phone Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you have any allergies?

Please list below the type of allergies that you have

Are you currently taking any medications that could affect your nail service?

Please list them below including vitamins and supplements

What are your hobbies?

Are you currently using or applying products to your nails? If yes, please list the name of the products below

When is the last time you had a professional nail service?

Nail condition

Other

Cuticle condition

Other

Do you have any cuts or wounds in your hands or feet?

Are you preparing for a special occasion?

COVID-19 Consent and Liability Waiver

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that Hustla G Studio LLC can not guarantee that I will not become infected with the Coronavirus/COVID-19. I understand that, because nail care services involve touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved and give consent to receive nail care services from the nail technician.

In taking part in this service, I agree, to the fullest extent permitted by law, to forever release, indeminify, defend and hold harmless Hustla G Studio LLC and its affiliates, related companies, owners, family of owner, friends, workers, contractors, officers, directors, members, employees, agents, representatives, partners, and licensors (collectively, the “Released Parties”) from any and all claims, liability, damages and/or costs (including attorneys’ fees) which, I might have or be entitled to assert as a result of or related to any physical injury or otherwise, including without limitation of death, property damage or loss sustained in connection with the services being rendered on my premises. I also agree to indemifiy, defend and hold harmless the Released Parties from any and all third party claims arising from any acts, errors or omissions.

I knowingly and willingly consent to nail services(s) during the COVID-19 pandemic.

By signing below, I confirmed that:

• All the information I entered in this form is accurate and true. I also authorized this Nail Technician to perform nail care service to my hands and feet.

• I have not had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days.

• I have not experienced any cold or flu-like symptoms within the last 14 days, including but not limited to shortness of breath or difficulty breathing, cough, fever, sore throat or any respiratory illness.

• I am aware of the booking policies listed on www.hustlagstudio.com

• I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures.

• I have read and fully understand the above paragraphs and I understand the services being rendered and accept the risks.

• Consent to Treatment of a Minor Under the Age of 17: By signing below, I hereby authorize a Licensed Nail Technician to administer nail services to my child or dependent as they deem necessary.

Client Signature

Date Signed

Date

Client Consultation Form

Health History

Nail Care Questions