MAKE ME BEAUTY LLC Advanced Foot Care Intake & Consent Form

MAKE ME BEAUTY LLC Advanced Foot Care Intake & Consent Form
1. Cosmetic Foot Care – Non-Medical Service
2. CLIENT INFORMATION
Name

First NameLast Name
Date of birthd

MonthDayYear
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
3. SERVICE SELECTION. Select the service(s) you are interested in:
Advanced Foot Care services are customized based on individual needs and may include a combination of cosmetic techniques for nail and skin maintenance.
4. FIRST VISIT. Is this your first visit?
5.FOOT CONDITION. Do you currently have:
6.HEALTH SCREENING. Do you currently have any of the following:
I confirm that I do not have open wounds, bleeding, or signs of active inflammation such as redness, swelling, pain, or discharge.

If any of these conditions are present, I understand that services may be refused for safety reasons and I should seek evaluation from a licensed healthcare provider.

I understand that providing incomplete or incorrect information may affect the safety and results of the service.
Initials
7.PHOTO & DOCUMENTATION CONSENT
I understand that photo documentation is required for Advanced Foot Care services for quality control, progress tracking, and service documentation.

Photos may include the condition of the nails and feet before and after the service.
initials
8.MARKETING PHOTO CONSENT
9.NON-MEDICAL DISCLOSURE

I understand that all services provided are cosmetic and non-medical in nature. No diagnosis, treatment, or medical procedures are performed.
10. NATURE OF SERVICES

Services include cosmetic nail and skin care, non-invasive techniques, and maintenance of foot appearance and comfort.
11. CLIENT RESPONSIBILITY

I understand that results may vary and multiple sessions may be required. I agree to follow aftercare instructions and inform the technician of any discomfort.
12. ASSUMPTION OF RISK

I voluntarily choose to receive these services and understand that mild sensitivity or temporary discomfort may occur.
13. RELEASE OF LIABILITY

To the fullest extent permitted by Florida law, I release Make Me Beauty LLC and its staff from any claims or liabilities related to the services provided.
Initials
14. INDEMNIFICATION

I agree to hold harmless Make Me Beauty LLC from any claims resulting from failure to disclose relevant conditions or follow aftercare instructions.
Initials
15. FINAL CONSENT

By signing below, I confirm that I have read, understood, and agree to all terms of this form.

I understand that services are cosmetic and non-medical, and I voluntarily consent to receive them.
Date

MonthDayYear
Date
Printed Name
Signature
Should be Empty:

MAKE ME BEAUTY LLC Advanced Foot Care Intake & Consent Form

7.PHOTO & DOCUMENTATION CONSENT