Manicure Consultation Form

Full Name: *

Date of Birth: *

Contact Number: *

Email: *

Are you currently taking any medications? *

Please list: *

Do you have any allergies? *

Please list: *

Have you recently been unwell? *

Which of the following were you unwell with? *

Please provide detail: *

Emergency Contact Name: *

Emergency Contact Relationship: *

Emergency Contact Phone: *

Select the treatment(s) you are interested in: *

Basic manicure Deluxe manicure Nail polish Gel / Shellac Acrylic French style Nail art

1. What are your hobbies? *

2. Do you usually wear gloves for cleaning, gardening, washing dishes etc.? *

3. How do you take care of your hands and nails? *

4. What products do you use on / apply to your nails? *

5. How long are your nails? *

6. What is the current condition of your nails? *

7. What is the current condition of your cuticles? *

8. Do you have any cuts or wounds on your hands? *

ANY ADDITIONAL NOTES/COMMENTS:

Signature: *

Tap or click on the signature above to sign