Pedicure Consultation Form

Client Details

Full Name: *

Date of Birth: *

Contact Number: *

Email: *

Medical Information

Are you currently taking any medications? *

Please list: *

Do you have any allergies? *

Please list: *

Treatments

Select the treatment(s) you are interested in *

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

Nail Care

1. Do you participate in any activities/exercise/sports where you mainly use your feet? *

2. How do you take care of your feet and toenails? *

3. What products do you use on / apply to your toenails? *

4. How long are your toenails? *

5. What is the current condition of your toenails? *

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

7. Do you have any cuts or wounds on your feet? *

ANY ADDITIONAL NOTES/COMMENTS:

Signature: *

Tap or click on the signature above to sign

Appointment Guidance

If you have tested positive for COVID-19, or have any symptoms of COVID-19 (see below) please do not attend your appointment. Please contact us as soon as you know you will be unable to attend so we can reschedule.

COVID-19 Symptoms:

a high temperature or shivering (chills) – a high temperature means you feel hot to touch on your chest or back (you do not need to measure your temperature)
a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours
a loss or change to your sense of smell or taste
shortness of breath
feeling tired or exhausted
an aching body
a headache
a sore throat
a blocked or runny nose
loss of appetite
diarrhoea
feeling sick or being sick