New Skincare/Wax Client Consultation Form

New Client Consultation Form

Nail Services
Date*

MonthDayYear
Name*

First NameLast Name
Date of Birth*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Website / Online SearchFacebookInstagramOtherReferral
If Referral, please list name
If Other, please let us know
What are your nail care goals?
YesNo
Natural NailsGel NailsAcrylic NailsNail Art
Your Health
Circulatory DiseaseHigh Blood PressureDiabetesPeripheral Artery DiseaseArthritisWarts/Plantars WartsFever BlistersHerpesCold SoresNail FungusAthlete's FootOtherNone
If you checked yes to any of these please provide further information. If not mark N/A
AspirinTree NutsLatexDairyFruitsVegetablesShellfishIodineFragrances / Essential OilsOtherNone
If Other, please specify
Post Nail Care Instructions: Avoid nail exposure to acetone and alcohol. When doing dishes or soaking hands for a long period of time, it is best to wear gloves. Be aware that certain medications and over the counter products can significantly increase the risk of injury when in combination with certain nail care services. Understand that there are often inherent risks associated with nail care services.*

I have read the post care instructions and agree to adhere to them.
Payment will be made via cash, check, or credit/debit card. Tap pay is also available. Payment will be collected prior to the service beginning. Students are able to be tipped by the Client. Tips cannot be added to a credit or debit card.
The Client may not receive a refund for any service already performed except under certain extreme circumstances as determined solely by the instructor or school owner. Refunds will be given to the Client if they have already paid for a service that they are unable to receive and the service has not yet been given. No refunds on opened retail products are allowed. A refund may be given to the Client who returns an unopened retail product within 7 calendar days of purchase.
I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. The treatments I receive here are voluntary and I release this nail care student, instructor, and school from liability and assume full responsibility thereof. I understand that I am choosing to receive a service performed by a student. All students perform services under licensed instructor supervision.*

Yes
Signature*
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New Client Consultation Form

Your Health