I have been working on this for days! I keep looking at other info on here and keep changing it lol. Have i missed anything or would you delete or add something else? I will have a separate profile/treatments. I just want this signed and and stored! I really value your opinions. Many thanks to you all xx
Client Consultation Form
Name:____________________________________________ Date of birth: __________________
Email: __________________________________Tel/Mob: _________________________________
Doctors signature required if you suffer with any of the following contra- indications ? Haemophilia, Diabetes, Medical Oedema, Arthritis, Nervous or Psychotic conditions, Recent Operations on Hands/Feet, Inflamed Nerve, Acute rheumatism . I suffer with_________________ I do not suffer from any of the above conditions (initial) _____ Are you are being treated for anything by a GP Dermatologist or any other practitioner? Yes/No Please provide details ___________________________________________________________
Doctors Signature I do not have any objection to my patient _________________________________ (name of Patient) receiving Nail and Beauty treatment/s
Doctors Signature/Stamp __________________________________ Date _____________
Restricted Contra-indications Are you currently suffering from any of the following? Fever, Infectious or contagious diseases, Under the influence of recreational drugs or alcohol, Diarrhoea and Vomiting ,Undiagnosed lumps or bumps, Inflammation, cuts, bruises, abrasions, Broken bones, scar tissue (2 years for major operations and 6 months for small scars), Recent fractures (minimum 2 months) , Repetitive strain injury, carpal tunnel syndrome, Nail separation, Eczema, Psoriasis, Dermatitis, Warts. I suffer with _____________________________________ I am currently not suffering from any of the listed (initial) ________
Are you sensitive to any cosmetic ingredients or do you suffer from a nut allergy or any other allergy? No/Yes, I am sensitive to ____________________________________________________
Do you have any condition that could affect service options such as, heart or circulatory conditions, cancer, slow healing, Epilepsy any skin/nail conditions or any other health problems not covered above? No/Yes If yes please ___________________________________________
I understand that I am responsible for notifying the nail technician of any changes in the future prior to any treatment. I understand that I CANNOT hold the nail technician responsible if I have knowingly been untruthful.
Client signature _______________________________________ Date _____________________
Under 16 years I have read the above and sign this consultation form on behalf of my daughter (Name) __________________________________ (who is not under 14 but under 16). I also give my consent for her to have the following (Nail/Beauty) treatment/s _____________________________
Parent/guardian signature _____________________________________ Date _________________
Client Consultation Form
Name:____________________________________________ Date of birth: __________________
Email: __________________________________Tel/Mob: _________________________________
Doctors signature required if you suffer with any of the following contra- indications ? Haemophilia, Diabetes, Medical Oedema, Arthritis, Nervous or Psychotic conditions, Recent Operations on Hands/Feet, Inflamed Nerve, Acute rheumatism . I suffer with_________________ I do not suffer from any of the above conditions (initial) _____ Are you are being treated for anything by a GP Dermatologist or any other practitioner? Yes/No Please provide details ___________________________________________________________
Doctors Signature I do not have any objection to my patient _________________________________ (name of Patient) receiving Nail and Beauty treatment/s
Doctors Signature/Stamp __________________________________ Date _____________
Restricted Contra-indications Are you currently suffering from any of the following? Fever, Infectious or contagious diseases, Under the influence of recreational drugs or alcohol, Diarrhoea and Vomiting ,Undiagnosed lumps or bumps, Inflammation, cuts, bruises, abrasions, Broken bones, scar tissue (2 years for major operations and 6 months for small scars), Recent fractures (minimum 2 months) , Repetitive strain injury, carpal tunnel syndrome, Nail separation, Eczema, Psoriasis, Dermatitis, Warts. I suffer with _____________________________________ I am currently not suffering from any of the listed (initial) ________
Are you sensitive to any cosmetic ingredients or do you suffer from a nut allergy or any other allergy? No/Yes, I am sensitive to ____________________________________________________
Do you have any condition that could affect service options such as, heart or circulatory conditions, cancer, slow healing, Epilepsy any skin/nail conditions or any other health problems not covered above? No/Yes If yes please ___________________________________________
I understand that I am responsible for notifying the nail technician of any changes in the future prior to any treatment. I understand that I CANNOT hold the nail technician responsible if I have knowingly been untruthful.
Client signature _______________________________________ Date _____________________
Under 16 years I have read the above and sign this consultation form on behalf of my daughter (Name) __________________________________ (who is not under 14 but under 16). I also give my consent for her to have the following (Nail/Beauty) treatment/s _____________________________
Parent/guardian signature _____________________________________ Date _________________
... These can be covered less specifically and more broadly in a Few simple sentences without being quite so literal. I think the whole thing is way over the top way too intrusive and way to personal. If I were asked to fill in this form before a service I would refuse ... Id rather walk out the door! No way would I give that sort of information about myself to a nail technician.
