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Manicure & Pedicure Consultation Form

manicure pedicure
This form should be completed prior to your first appointment, when it has been longer than 6 months between appointments or when there has been a significant change to your medical history or lifestyle that could impact upon your Manicure / Pedicure / Nail treatments. 

Client Contact Details

Age
Teen
20-30
31-40
41-50
51-60
61+

Emergency Contact Details

Medical Details

Have you been under medical care in the last 6 months?
Yes
No
Have you undergone surgery within the last 6 months?
Yes
No
Within the last 6 months have you had any medically prescribed acne products e.g. Roaccutane / Retinol / Retain A / Retinova / Tarozac / Other?
Yes
No
Do you suffer with any neck or spinal injuries?
Yes
No

Lifestyle

Do you have a history of picking or biting at your nails?
Yes
No
Do you smoke?
Yes
No
Do you use sunbeds or sunbathe?
Yes
No
Do you swim regularly or have your hands submerged in water?
Yes
No
Are you currently ... (please tick all that apply)

Skin Concerns

Please indicate whether you are affected by any of the following
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