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MANICURE / PEDICURE- CLIENT INTAKE FORM

CLIENT INFORMATION

Birthday
Year
Month
Day
What appointment are you booked in for?
Manicure
Pedicure
Is this your first visit to Stillwater Esthetics?
Yes
No
How did you hear about Stillwater Esthetics?
Facebook
Google Search
Family/ Friend
Instagram
Existing Client Referral
Other

HAND AND FOOT SERVICE HISTORY

Do you currently have ANY gel/shellac polish on your fingernails/toenails? Even if gel/shellac polish remains on only ONE nail, please select Yes.
Yes- I understand I must book a Gel/Shellac Polish Removal
No

IMPORTANT NOTE: Shellac/Gel Polish removal, requires additional time and must be booked prior to service, whether polish remains on 1 nail, or all 10 nails (price will be adjusted accordingly).

HEALTH AND SAFETY SCREENING

Do you have any of the following concerns with your nails?
Have you ever had a reaction to a nail service before?
Yes
No
Please select any of the following that apply to you
Do you have any allergies or sensitivities to any of the following?

SERVICE SAFETY POLICY

For your safety, Manicure or Pedicure services cannot be performed over suspected fungal infections, contagious conditions, or open wounds. Services may be modified or postphoned, and a referral may be recommended.

INFORMED CONSENT AND LIABILITY WAIVER

I confirm the information provided is accurate and complete. I understand nail services involve tools, filing, trimming and cosmetic products. I agree to report any discomfort immediately. I release Stillwater Studio and Day Spa by Stacy Schreiner ("Stillwater Esthetics") and staff, from liability related to undisclosed conditions or allergies.

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Date
Year
Month
Day
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