• New Model Intake Form

  • Model Contact:

     
  • Format: (000) 000-0000.
  • How often do you get a service completed on your nails?*
  • Have you damaged or lost a fingernail that has caused it's growth to be different than your other fingernails?*
  • Do you have any current injuries/damage or fungal infection on your hands/feet (including cuticle damage, cracked/torn nails)*
  • Do you have any known medical or skin condition that might affect your hands or feet?*
  • Do you have any blood disorder or chronic viral infections that are transmittable? (ex.(not limited to) Hepatitis, Herpes Simplex Virus, HIV)
  • Do you have Diabetes?*
  • Are you pregnant?*
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  • You are aware that I am a student Nail Technician who is not liable for any previous or new damage/injuries on hands or feet.*

  • This is required to be completed before scheduling an appointment for a service to be completed. All of the information entered above must be an accurate record of health. You acknowledge MADICUREDIT and ROMEROBEAUTYLLC are not liable for any existing or new damage cause by services completed. By signing this agreement you recognize you are a model for Madison Douglas's (MADICUREDIT) student Nail Technician practice as a student of ROMEROBEAUTYLLC. 

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