Consultation Form

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is the client pregnant?

Does the client have any allergies?

If you have allergies please state here.

Does the client have diabetes?

Does the client have any contagious skin conditions?

If so please state here.

Is the client under 16?

If you are under 16 please ask for parents/guardians permission and bring a parent/ guardian to the appointment.

Parents signature if under 16 years old

i agree as a client that I must inform NailsByElla of any changes to my medical concerns if they were to change.

Clients Signature

Nails By Ella