New Skincare/Wax Client Consultation Form

New Client Consultation Form

Nail Services
Date *

Month Day Year
Name *

First Name Last Name
Date of Birth *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
How did you hear about me?

Website / Online Search Facebook Instagram Other Referral
If Referral, please list name
If Other, please let us know
What are your nail care goals?
Have you ever had a nail service before?

Yes No
What nail services interest you?

Natural Nails Gel Nails Acrylic Nails Nail Art
Your Health
Have you experienced any of these health conditions in the past or present? *

Circulatory Disease High Blood Pressure Diabetes Peripheral Artery Disease Arthritis Warts/Plantars Warts Fever Blisters Herpes Cold Sores Nail Fungus Athlete's Foot Other None
If you checked yes to any of these please provide further information. If not mark N/A
Any known allergies? *

Aspirin Tree Nuts Latex Dairy Fruits Vegetables Shellfish Iodine Fragrances / Essential Oils Other None
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 Methods *

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.
Refunds *

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 *

Clear
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform

New Client Consultation Form

Your Health