Nail Technician Client Consultation Form

Nail Technician Client Consultation Form
Client's Name

First Name Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Occupation
Services you would like

Manicure Gel Polish Upgrade Pedicure Paraffin Upgrade Aveda Aroma Manicure Renewal Upgrade Aveda Aroma Pedicure Plant Peel Upgrade Conversion Manicure Nail Art
Health History
Current Health Conditions: (Please select below)

Diabetes Varicose Veins Skin Disease Hypertension Fungal Infection Bone problems Pregnancy Cardiovascular Disease Hepatitis A Hepatitis B HIV Other
Do you have any allergies?

Yes No
Please list below the type of allergies that you have
Have you undergo any surgical procedure?

Yes No
Please list the name of the procedure and the reason
Are you currently taking any medications?

Yes No
Please list them below including vitamins and supplements
Nail Care Questions
What are your hobbies?
Are you wearing gloves if you clean the house, do the gardening, or washing dishes?

Yes No
How do you take care of your hands?
How do you take care of your feet?
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?
How often do you go to a nail salon?
Nail condition

Split Peel Crack
Cuticle condition

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

Yes No
Are you preparing for a special occasion?

Yes No
Do you have anything on your nails now? If so, what is it?
By signing below, I confirmed that all 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.
Client Signature

Clear
Date Signed

Month Day Year
Date
Should be Empty:

Nail Technician Client Consultation Form

Health History

Nail Care Questions