Nail Technician Client Consultation Form

New Client Consultation Form

Please fill this form out to the best of your knowledge.
Client's Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Nail Care Questions
YesNo
Are you currently using or applying products to your nails? If yes, please list the name of the products below*
Type N/A if not applicable
When is the last time you had a professional nail service?*
How often do you go to a nail salon?*
YesNo
SplitPeelCrackN/AOther
DryTornInflamedN/AOther
YesNo
YesNo
YesNo
YesNo
NormalDryOilySensitiveCombination
YesNo
Enter Email Address
Health History
DiabetesHeart DiseaseSkin DiseaseHypertensionFungal InfectionCirculatory DiseasePregnancyCardiovascular DiseaseHepatitis AHepatitis BHIVThyroid ProblemsN/AOther
YesNo
Please list below the type of allergies that you have*
Type N/A if not applicable
YesNo
Please list them below including vitamins and supplements*
Type N/A if not applicable
I confirm that I have not been diagnosed with COVID-19 in the last 14 days.I agree NOT to visit the salon for any services provided if I the symptoms of COVID-19.I am allowing the nail technician to apply necessary chemicals as part of the service in my nail treatment.
By signing below, I confirmed that all information I entered in this form is accurate and true. I also authorize this Nail Technician to perform nail care service to my hands.
Client Signature*

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Date Signed*

MonthDayYear
Date
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New Client Consultation Form