Surveypoint

Q1

Client's Name

First Name

Q2

Client's Name

Last Name

Q3

Email

Q4

Phone Number

Q5

Address

Street Address

Q6

Address

Street Address Line 2

Q7

Address

City

Q8

Address

State / Province

Q9

Address

Postal / Zip Code

Q10

Occupation

Q11

Services you would like

Hot oil manicure

Spa manicure

Soak-off gel manicure

Paraffin wax manicure

Brazillian manicure

Shellac manicure

Acrylic manicure

Basic manicure

Hot stone manicure

Mirror manicure

Q12

Current Health Conditions: (Please select below)

Diabetes

Varicose Veins

Skin Disease

Hypertension

Fungal Infection

Bone problems

Pregnancy

Cardiovascular Disease

Hepatitis A

Hepatitis B

HIV

Other

Q13

Do you have any allergies?

Yes

No

Q14

Have you undergo any surgical procedure?

Yes

No

Q15

Are you currently taking any medications?

Yes

No

Q16

What are your hobbies?

Q17

Are you wearing gloves if you clean the house, do the gardening, or washing dishes?

Yes

No

Q18

How do you take care of your hands?

Q19

How do you take care of your feet?

Q20

Are you currently using or applying products to your nails? If yes, please list the name of the products below

Q21

When is the last time you had a professional nail service?

Q22

How often do you go to a nail salon?

Q23

Nail condition

Split

Peel

Crack

Q24

Cuticle condition

Dry

Torn

Inflamed

Q25

Do you have any cuts or wounds in your hands or feet?

Yes

No

Q26

Are you preparing for a special occasion?

Yes

No

Q27

Would you like to receive promotions and offers via email?

Yes

No

Q28

Client Signature

Q29

Date Signed

Date

Nail Technician Client Consultation -Form Fill

Client's Name

Client's Name

Email

Phone Number

Address

Address

Address

Address

Address

Occupation

Services you would like

Current Health Conditions: (Please select below)

Do you have any allergies?

Have you undergo any surgical procedure?

Are you currently taking any medications?

What are your hobbies?

Are you wearing gloves if you clean the house, do the gardening, or washing dishes?

How do you take care of your hands?

How do you take care of your feet?

Are you currently using or applying products to your nails? If yes, please list the name of the products below

When is the last time you had a professional nail service?

How often do you go to a nail salon?

Nail condition

Cuticle condition

Do you have any cuts or wounds in your hands or feet?

Are you preparing for a special occasion?

Would you like to receive promotions and offers via email?

Client Signature

Date Signed