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Client Intake Form - Nails

This document is a client intake form for nail services. It collects information such as the client's name, contact details, medical history, known allergies, nail concerns and activities that could affect the nails. The client must sign to confirm the accuracy of the information and that they understand the salon's policies regarding health conditions and contamination risk. For minors, a parent or guardian must also provide consent.

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GGenZ Consulting
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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395 views2 pages

Client Intake Form - Nails

This document is a client intake form for nail services. It collects information such as the client's name, contact details, medical history, known allergies, nail concerns and activities that could affect the nails. The client must sign to confirm the accuracy of the information and that they understand the salon's policies regarding health conditions and contamination risk. For minors, a parent or guardian must also provide consent.

Uploaded by

GGenZ Consulting
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Date:

Male Female

CLIENT INTAKE FORM - NAILS


Name Date of Birth

Address City

State Zip Email

Phone Referral

Emergency Contact EC Phone

Date of your last professional manicure or pedicure:


How often do you get professional manicures and pedicures?
What hand, foot and nail products do you most frequently use?
How long does your nail or toe polish usually last?
How would you like to improve your hands, feet and nails?
What type of hobbies and activities do you do that directly affect your nails?

For the questions below, please circle all the answers that apply:
Do your nails: Split Peel Crack Break
Are your cuticles: Dry Torn Ragged Inflamed/Red
Do you bite your nails? Yes No
On your hands, do you have: Open Wounds Cuts Sores Bruises Tenderness
Have you ever been diagnosed with any of the following: AIDS HIV Hepatitis A or B
Please list any known allergies including food, medicines, scents, plants, etc.:
Are you diabetic? Yes No
Are you pregnant? Yes No
Have you ever had or do you now have a nail infection on any of your fingernails or toenails? If so, please explain:

By signing below, you attest that you have provided accurate and current information on this form and answered all medical and health-re-
lated questions truthfully and completely. Your signature also certifies that you understand that b Salon & Spa 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 responsi-
ble for informing b Salon & Spa and/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.
Client Signature Date

Consent to Treatment of Minor: By signature below, I hereby authorize b Salon & Spa to administer service(s) to my child or dependent as
they deem necessary.
Signature of Parent or Guardian Date
DATE APPT. NOTES TECH.

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