Nail Service Client Intake Form
Please answer all questions to the best of your ability to help me understand your nail health and goals before your appointment
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Do you have any of the following medical conditions? Please select all that apply
*
Diabetes
Blood-borne diseases (such as HIV/AIDS)
Pregnancy
Arthritis in your hands/arms
Excessive nail biting (onychophagia)
None of the above
Have you previously had any allergic reactions to any chemicals used in nail services, such as acetone, monomer (acrylic liquid), polishes, cuticle oils, primers, etc?
*
Yes
No
Unsure
Please list your occupation and explain how you use your hands at work (ex. Secretary, lots of typing/writing):
*
Please list your hobbies & activities, including sports and exercise:
*
Do you take extra care of your nails at home (hand creams, cuticle oils, cuticle care, trimming/filing, etc)?
*
What types of nail services have you had in the past (please select all that apply)
*
Acrylic
Dip powder/SNS
Gel/Laquer Polish
Hard/Builder/Structured Gel
Polygel
Gel X
Manicure/regular polish
None of the above
Have you ever developed a nail/fungal infection from any nail service?
*
Yes
No
Unsure
Are you sensitive to LED/UV light curing (do you experience heat spikes)?
*
Yes
No
Unsure
Do you bite or pick at your nails/cuticles (with or without enhancements)
*
Yes
No
only without enhancements
only with enhancements
I agree that I have read and will follow all Gloss Girl Nail Lounge policies and have answered this form to its entirety and to the best of my ability.
*
Continue
Continue
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