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
Services you would like*

Standard manicureNail RepairGel ManicureGel / Acrylic RemovalAcrylic Full SetOther (please specify in the Notes box at the end of page)
Current Health Conditions: (Please select below)*

DiabetesSkin DiseaseFungal InfectionBone problemsNoneOther (please specify in the Notes box at the end of page)
Do you have any allergies?*

YesNo
Please list below the type of allergies that you have
Are you currently taking any medications?*

YesNo
Please list them below including vitamins and supplements
Are you wearing gloves if you clean the house, do the gardening, or washing dishes?*

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?*
Nail condition*

SplitPeelCrackGood
Cuticle condition*

DryTornInflamedNormal
Do you have any cuts or wounds in your hands or feet?*

YesNo
Are you preparing for a special occasion?*

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*

Clear
Date Signed*

MonthDayYear
Date
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