Please read
***Please only complete this form after your appointment has been confirmed***. This form should be completed prior to your appointment date.
Date
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Month
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Day
Year
Date
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Birthday
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Month
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Day
Year
Date
How did you hear about me (tell me everything 🥰 ha)
Personal Health History | Please mark all that apply or none
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Previous history of contact dermatitis
Precious or existing nail infection on any of your fingernails or toenails
Existing open wounds, cuts, bruises, tenderness or rash/irritation
Allergy to gel polish ingredients (Methacrylates, benzoyl peroxide, hydroquinone, acrylates, formaldehyde, toluene, dibutyl phthalate, expoxy resin, sulfonamide)
Allergy to acrylic ingredients (acrylate monomers, formaldehyde resin, methacrylates, liquid methacrylates acid esters, benzoyl peroxide, hydroquinone)
Currently using topical medications on the hands or feet (e.g retinol, acne medication)
Allergy to UV light
Allergy to LED light
Nail injury or other illness
Nail discomfort or pain
Pregnant or breastfeeding
NONE APPLY
Have you experienced any discomfort or pain with previous nail services? If yes, please explain.
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Signature
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Please agree to the terms and conditions
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I hereby agree to have nail services performed on my natural nails and consent to placement and/or removal of gel/acrylic products by a certified professional. I also agree that all treatments are voluntary and release the professional from liability.
I attest that I have provided accurate and current information on this form and answered all questions truthfully and completely. I understand the above named professional reserves the rights to deny service due to a health condition or risk.
I understand and agree to follow the aftercare instructions provided to me and any understand that not following hand hygiene and care post appointment may cause risk. If I encounter any issues, I will notify my nail technician immediately and within 24 hours for immediate removal.
I understand that due to the nature of wear and tear of nails, I will remove nail product from nails in a safe and sanitary fashion to avoid any damage or injury to the nail. This can be done by booking an appointment with your nail technician.
I consent to “before” and “after” photos, including recording.
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