Client's Name
*
First Name
Last Name
Phone No
*
Email
*
Date of birth
*
DD-MM-YYYY
Address
Street Address
Street Address Line 2
City
State / Province
Post Code
Services you would like
*
Gel - X Full Set
Gel Polish Manicure
SNS/ Dip
Pedicure With Gel Polish
Acrylic Fill- In
Nail Repair
Gel / Acrylic Removal
Other (please specify in the Notes box at the end of page)
Current Health Conditions: (Please select below)
*
Diabetes
Skin Disease
Fungal Infection
None
Other (please specify in the Notes box at the end of page)
Do you have any allergies?
*
Yes
No
Please list below the type of allergies that you have
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
Good
Cuticle condition
*
Dry
Torn
Inflamed
Normal
Do you have any cuts or wounds in your hands or feet?
*
Yes
No
Are you preparing for a special occasion?
*
Yes
No
NOTES or Anything else I should to be aware of
Book Session
Should be Empty: