Nail Salon Client Consent and Acknowledgement

Please read this form carefully. Your signature below indicates that you have read, understood, and agree to its terms. Client Information

Full Name: Date of Birth: Phone Number:

Health and Medical Information To ensure your safety and the best possible service, please disclose any relevant health conditions, allergies, or medications. All information provided will be kept confidential.

Are you currently taking any medications (e.g., blood thinners, Accutane, etc?

[] Yes No

If Yes, please list:

Do you have any known allergies (e.g., to latex, acrylic, gel, polish ingredients, chemicals, dust, etc?

[] Yes No

If Yes, please list:

Do you have any skin conditions, sensitivities, or disorders affecting your hands or feet (e.g., eczema, psoriasis, fungal infections, warts, cuts, open wounds, swelling, recent injuries, diabetic neuropathy)?

[] Yes No

If Yes, please describe:

Are you pregnant or breastfeeding?

[] Yes No

Have you recently had any medical procedures or conditions that might affect nail services (e.g., chemotherapy, radiation, surgery on hands/feet)?

[] Yes [] No

If Yes, please describe:

Is there anything else we should be aware of regarding your health or nails?

[] Yes [ No If Yes, please describe:

Understanding of Nail Services and Risks

I understand that nail services involve certain inherent risks, including but not limited to: Allergic reactions: To products such as gels, acrylics, polishes, or other chemicals. Infections: If proper aftercare is not followed or if pre-existing conditions are present. Nail damage: Such as thinning, brittleness, or lifting, especially with improper removal or prolonged use of certain products. Skin irritation: Redness, itching, or discomfort around the nail area.

Minor cuts or abrasions: Which can occur during manicure or pedicure procedures. Reactions to UV/LED light: Used in some nail services. I confirm that I have accurately completed the health and medical information section to the best of my knowledge and have informed the nail technician of any conditions that may affect my service. I understand that failure to disclose relevant information may result in adverse side effects for which the salon and nail technician cannot be held responsible.

| voluntarily consent to receive the nail services requested. I confirm that I have been given the opportunity to ask any questions about the procedures and potential risks involved, and that my questions have been answered to my satisfaction. I understand that if I experience any discomfort or adverse reactions during or after the service, Ishould inform the nail technician or salon management immediately.

I acknowledge and accept the inherent risks associated with nail services as described above. I understand that this consent form does not release 5by5 Nail Salon or its nail technicians from liability for death or personal injury caused by their negligence, or for any other liability that cannot be excluded or limited by law. However, by signing this form, I agree not to hold 5by5 Nail Salon or its nail technicians liable for any injury, reaction, or damage that arises from my failure to disclose relevant medical or allergy information, my failure to follow aftercare instructions, or from the inherent, foreseeable risks of the treatment that are not caused by the negligence of 5by5 Nail Salon or its nail technicians.

I understand that following aftercare instructions provided by my nail technician is crucial for the longevity and health of my nails and for minimising risks. I agree to follow these instructions diligently.

confirm that I have read and understood this consent form and agree to its terms. Client Signature: Printed Name: