• Client Health Questionnaire

    All information is held in the strictest confidence. At no given point is information disclosed or shared without client’s written consent. 

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  • Medication and allergy history

  • What treatments are you interested in?

  • Treatment Policies:

    Client services and chart information are confidential. Written authorisation is required from you to release any information.

           • Please bring minimal personal belongings with you and refrain from touching them whilst your treatment is in progress.

           • Please attend your appointment alone.

           • Please ensure you arrive on time. Not early or late. This allows for no client overlapping and cleaning/disinfecting time.

           • 48 hour cancellation notice is required to avoid being charged for your session (unless COVID related).

           • Please adhere to the new Potter's Pinkies guidelines at all times (attached).

           • If you arrive more than 10 minutes late Potter's Pinkies reserves the right to reschedule your appointment.

           • Please attend your appointment already wearing your OWN face mask/covering.

           • Please use the shoe covers provided by Potter's Pinkies before entering the premises.

           • Potter's Pinkies now operates a bank transfer only payment system.

     

    Client Agreement:

    I understand that Potter's Pinkies cannot advise medically on skin conditions or health issues but they can advise I seek medical advice from my GP and have the right to refuse treatment if deemed necessary.

    It is my choice to visit Potter's Pinkies for my nail treatment(s).

    I understand that the treatment given is designed to best suits my needs, based on this form and our consultation prior to treatment commencing.

    I also understand that if I have omitted any information from this form it is my responsibilty and I do not hold Potter's Pinkies responsible in any way should something happen.

    I have filled this questionnaire in to the best of my knowledge at the time of signing and understand it is my responsibility to update Potter's Pinkies immediately should anything change.

    I understand that my failure to do so may pose a threat to my health and physical well being and I will not hold Potter's Pinkies responsible for any liability whatsoever arising from failure on my part.

    By electroncally signing below, I agree to the treatment policy and client agreement above. 

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