Client Consultation/Consent Form

Do you have any conditions that might affect service?*

	Yes	No
Severely Bitten Nails
Severely Bitten Cuticles/Skin
Diabetes
Skin Irritation
Skin Inflammation
Arthritis
Blood Borne Disease
Hemophilia
Recent Hand/Foot Surgery
Swelling
Calluses
Athlete's Foot
Nail Infection
Corns
Allergies
Hyperhidrosis
NONE OF THESE APPLY

Other: Please Explain
I understand that certain conditions listed above may result in the appointment being rejected. I acknowledge that due to certain health conditions above, service performed can be affected and may not be safe
I, Full Name* , declare that I have read this consultation form thoroughly and I understand every question asked. I believe I have no medical condition that may affect the treatment. All of the given answers are correct and true to the best of my knowledge.
Signature*

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