Client Consultation Form

1

Client Consultation FormName:

First Name

Last Name

2

Email

example@example.com

3

Phone Number

Please enter a valid phone number.

5

Do you have any allergies?

Yes

No

6

Please list below the type of allergies that you have

7

Are you wearing gloves if you clean the house, do the gardening, or washing dishes?

Yes

No

9

Cuticle condition

Dry

Torn

Inflamed

10

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

Yes

No

11

Are you feeling any type of pain in your hands or feet that cannot sustain any massage pressure?

Yes

No

12

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.

13

Client Signature

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14

Date Signed

Date