Belleza x Evelyn
Client Intake Form
Please verify that you are human
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Full Name
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First Name
Last Name
Phone Number
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-
Area Code
Phone Number
E-mail
example@example.com
Date of Birth
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Month
-
Day
Year
Date
How did you hear about BellezaxEvelyn?
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Referral
Instagram
Tiktok
Business card
Other
If you were referred, who recommended BellezaxEvelyn?
Preferred Language
English
Spanish
Heath History
Please check any of the following options that may apply to you
Do you have, or have you had, a history of:
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Diabetes
Heart Disease
Thyroid Problems
Circulatory or Muscular Disease
Hypertension
Cancer
Allergies
Sensitivity to any products
N/A
Other
Please elaborate if any allergies or other concerns:
Are you currently pregnant?
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Yes
No
Are you currently taking any medications?
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Yes
No
If so, please elaborate here:
How do you prefer your service?
Silence
Music
Conversation
Movie/Show
Other
Additional Comments/Questions
Terms and Conditions
Please read through and accept the terms and conditions. By checking the following boxes you are affirming that you understand and will comply by these terms:
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If lifting is due to improper care Evelyn and BellezaxEvelyn are not liable
When lifting occurs, it is crucial that the client takes the initiative to get nails repaired/removed. Lifting can trap moisture under the nail, encouraging bacteria growth which results in the “greenies”. If this does occur, Evelyn and BellezaxEvelyn are not liable
I have read the policies under the “policy” highlight on @bellezaxevelyn on Instagram (or booking site under “cancellation policy”), understood, and agreed to them
Client Signature
By signing you are affirming that you have provided all necessary information and have read and accepted the terms and conditions
Signature
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