Nail Technician Client Consultation Form
Client's Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Services you would like
Just A Really Good "Waterless" Pedicure
Just A Really Good "Spa" Pedicure
Just A Really Good "Restorative" Pedicure
Services you would like
Just A Really Good "Express" Manicure
Just A Really Good "Hot Oil" Manicure
Just A Really Good "Overlay" Manicure
Just A Really Good "Gel" Manicure
Just A Really Good "Spa" Manicure
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
Would you like to receive promotions and offers via email?
Yes
No
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
Date Signed
-
Month
-
Day
Year
Date
Book Session
Should be Empty: