CLIENT CONSULTATION FORM
Disclaimer: Thank you for your interest in being a client of Knick-Knack Nails. Information collected about new clients is confidential and will be treated accordingly.
Client Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Gender
*
Preferred Pronouns
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact
*
Full Name
Phone Number
Your Nails & Hands
When was your last professional manicure?
*
How often do you get professional manicures?
*
Regularly
Special Occasions
Rarely
First time, but I'd like to start regularly
What hand and nail products do you most frequently use?
*
How would you like to improve your hands and nails?
*
What type of hobbies, work, and activities do you do that directly affect your nails?
*
Are your hands in water frequently, or do you use harsh cleaning chemicals? Do you use gloves when using harsh cleaning products (dawn dish soap, laundry detergent, bleach, etc.)?
*
Do your nails? (select all that apply)
Split
Peel
Crack
Break
Are your cuticles? (select all that apply)
Dry
Torn
Ragged
Inflamed/Red
Do you currently have any hang nails?
*
Yes
No
Do you bite your nails?
*
Yes
No
On your hands, do you have? (select all that apply)
*
Open Wounds
Cuts
Bruises
Tenderness
Rash/Irritation
Your Health
Have you ever had or do you currently have a nail infection on any of your fingernails or toenails?
*
Yes
No
If yes, please provide more detail:
Current Health Conditions:
*
Diabetes
Varicose Veins
Skin Disease
Hypertension
Fungal Infection
Cardiovascular Disease
Pregnant
Hepatitis A
Hepatitis B
HIV/AIDS
None
Other
If other, please provide more detail:
Do you have any allergies? (including food, medicines, scents, plants, etc.)
*
If none, type n/a
Preferences
Neither field is required, but here just in case :)
Please upload any inspo pics here:
Browse Files
Drag and drop files here
Choose a file
Up to 5*
Cancel
of
Would you prefer a quiet, relaxing service today (little to no interaction), or would you like to catch up?
Quiet
Catch up
Read & Accept
By signing below, you attest that you have provided accurate and current information on this form and answered all medical and health-related questions truthfully and completely. Your signature also certifies that you understand that the above-named salon reserves the right to deny service to any client due to a health condition he or she has that may pose a potential risk to practitioners or other clients, including those that pose a risk of potential contamination to service areas. Furthermore, signing below verifies that you understand that you are responsible for informing the above-named salon or its manicure and pedicure technicians of ANY and ALL changes to your health condition as regards any question on this form or any potential public health risk that may arise from any change in your health condition. You acknowledge and accept that withholding information or providing misinformation may result in contraindications or irritation to the nails and skin from treatments received. The treatments you receive here are voluntary and you release this nail care professional and the above-named salon from liability and you assume full responsibility thereof.
Signature
*
Continue
Continue
Should be Empty: