Have you ever had an allergic reaction to any type of nail enhancement or other nail related products?
How would you describe your current nails condition:
Have you ever had or do you now have a nail infection on any of your fingernails or toenails?
Do you do household cleaning, gardening or dish washing by hand?
On your hands, do you have: Open Wounds, Cuts, Sores Bruises, Tenderness?
I hereby consent and acknowledge the following:
I acknowledge that side effects can occur and I fully accept the risk. I understand that my Nail Technician, will take every precaution to minimize or eliminate negative reactions as much as possible. I will consult my Nail Technician first should I have any complications after receiving my treatment. I have been given the opportunity to ask questions and any questions have been answered to my satisfaction.
Medical Pedicure/Manicure/Other Nail Service is a non-covered insurance benefit and should be purchased separately through Groupon/in the office/ from other marketing resources.
I have read the information and recorded my medical history accurately with all pertinent information. For future services, I agree to inform my spa technician of any changes in my medical status and/or the above information. I understand spa services are not to be considered medical treatment, and as such, the Nail Technician cannot prescribe treatment of pharmaceuticals.
I agree that my Nail Technician may determine that it is unsafe for you to continue a treatment due to health related concerns. In this event you may be required to provide a medical release from your physician prior to continuing treatment.
I confirm that the information given above is correct, and that to my knowledge, I have not withheld any information that may be deemed relevant to the treatment I am receiving. I take responsibility for any side effects should they occur. I consent to the Nail Procedure with the understanding that it is an elective procedure, no medical claims are expressed. I will follow the verbal and written aftercare advice given to me.
Photo and Video Release
I would like your permission to use these photos for advertising. For example: Portfolios, online and print ads, etc. Your consent is necessary regarding this. Please indicate with your signature if you would like your photos used or not used in advertising. We also like to tag our clients in photos used on our Instagram profile! Please indicate if you’d like to allow this or not below.
How did you find out about us?
By signing below, you agree to the following:
I have completed this form truthfully and to the best of my knowledge. I agree to inform the technician of any
changes in the above information. I agree that I do not have any condition/s that would make the requested
treatment unsuitable. I agree to waive all liabilities toward my technician and the employer for any injury or
damages incurred due to any misrepresentation of my health.