Nail Client Consultation Form

Client's Name*

First NameLast Name

Phone Number*

Email*

Date of birth*

DD-MM-YYYY

Address

Street Address

Street Address Line 2

CityState / Province

Post Code

Referred by:

How did you find out about us?

YesNo

Please list below the type of allergies that you have

YesNo

If so, please list medications down below:

YesNo

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?*

YesNo

SplitPeelCrackGood

DryTornInflamedNormal

YesNo

If so, what happened and what could have made it better?

Notes or anything else I should to be aware of

By signing below, I confirm that all information I entered in this form is accurate and true and answered all medical and health related questions truthfully and completely. Your signature certifies that you understand that the service provider reserves the right to deny service to any client due to a health condition he or she has that may pose a potential risk to the practitioner or other clients; including those that pose a risk of potential contamination to service areas. Furthermore, signing below verifies that you understand that you are responsible for informing the service provider of ANY and ALL changes to your health condition as regards any question on this form or any potential public health risk that may arise from any change in your health condition.

I agree for any photos taken during and after the treatment to be used for marketing purposes.

By signing below, I agree to all salon policies

Con Amor Beauty Studio Policies

Client Signature*

Date Signed*

Date