Client Consultation Form for Polish Me Pretty Nails by Camille

Hi!

My name is Camille Suarez and I am a Nail Technician in Jacksonville Florida. I have been in the nail industry for the last 14 years! I specialize in nail extentions and cuitcle care! If you are interested in recieving services go ahead and fill out the form below for a consultation and I will reach out to set up a 10 minute phone call! I look forward to servicing you soon!
Client's Name*

First NameLast Name
Phone No*
Email*
Date of birth*
DD-MM-YYYY
Standard manicureNail RepairGel ManicureGel / Acrylic RemovalAcrylic Full SetOther (please specify in the Notes box at the end of page)
DiabetesSkin DiseaseFungal InfectionBone problemsNoneOther (please specify in the Notes box at the end of page)
YesNo
Please list below the type of allergies that you have
YesNo
Please list them below including vitamins and supplements
YesNo
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?*
SplitPeelCrackGood
DryTornInflamedNormal
YesNo
YesNo
NOTES or Anything else I should to be aware of
By signing below, I confirmed that all information I entered in this form is accurate and true. I authorized this Nail Technician to perform nail care service to my hands and feet. I agree for any photos taken during and after the treatment to be used for marketing purposes.
Client Signature*
Date Signed*

MonthDayYear
Date
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