CLIENT CONSULTATION FORM

Dear Client,

Its my great pleasure to provide you with the best services ever. I hope that this experience holds a valued place in
your memory and ripples a long-lasting relationship that benefits both you and I. In order for this experience to be
the best you ever had, I would like to learn more about you, your needs within my service and your preferences.
Please bless me with your time and answer the following questions as completely and accurately as possible.

Thank you for choosing us to privide your services, we look forward to providing a quality customer experience .

Service for Client’s Consultation:Pedicure Appointment

Date of Consultation: __________________________________

Name: _____________________________________________________________

Address:____________________________________________________________

__________________________________________________________________

Phone Number: ___________________________ Sex: [ ] Male [ ] Female

Email: ________________________________________________________

How did you hear about the salon?__________________________________________

If you were referred, who referred you?_______________________________________

Please answer the following questions in honesty, it’s with your best interest in mind that the following questions
are being asked, Thank You.

What is the occasion/reason for this visit?_____________________________________

Approximately how long ago was your last nail service and what was the outcome of that ?
_______________________________________________________________

How would you describe your nail length? [ ] Long [ ] Average [ ] Short

Which of the following best describes your nail strength: [ ]Strong [ ] Normal [ ] Weak

How would you describe the health of your nails? _________________________________________

Are you currently in the care of a physician, if yes, please state why:
_____________________________________________________________________________
What type of manicure are you interested in for this service? ________________________

What is the nail length you would like to achieve with this service? [ ] Long [ ] Average [ ] Short

What is the nail color/design you desire to have done during this service? ____________________

Are you aware that any unrealstic color or design may not be as successful on your nails as
pictured/imagined?

[ ] Yes [ ] No

What shape would you like to have your nails done in at this service?

[ ] Square [ ] Squoval [ ] Round [ ] Oval [ ] Almond [ ] Coffin [ ] Stiletto [ ] Mountain [ ] Edge [ ] Other

Are you aware if fungus is present on your nails/skin? [ ] Yes [ ] No

If yes, were you been daignosed by a physician, has the area been treated and have you been
released from care?
_____________________________________________________________________________
Are you now, or have you ever been allergic to any of the products, treatments or chemicals
you’ve received during any pedicure service? [ ] Yes [ ] No

If yes, please state:_____________________________________________________

__________________________________________________________________

Are you currently taking any of the following medications?

[ ] Acne Medication containing Vitamin A (retinoids)

[ ] Antibiotics and Antifungal drugs [ ] Birth Control Pills

[ ] Cancer Treatment Drugs [ ] Epilepsy Drugs

[ ] High blood pressure medications (Anti-hypersentives) [ ] Hormonal Drugs

[ ] Mood Stabilizers [ ] Steroids

[ ] Weight Loss Drugs [ ] Other

Is any of the following medical conditions applicable to you?

[ ] Cancer [ ] High Blood Pressure [ ] Arthritis

[ ] Anxiety/Depression [ ] Heart Problems [ ] Thyroid Disease

[ ] Pregnancy/Childbirth /Menopause

If you are pregnant what trimester are you in? ___________________________________________

Is there anything else you want your service provider to know about? [ ] Yes [ ] No
__________________________________________________________________
__________________________________________________________________

Would you like to schedule another apppointment? If yes please state when you would like you
next appointment to be (approximately, doesn’t have to be the exact date):
__________________________________________________________________

In order for our standard of services to remain consistenet it is important that you the client try
your best to maintain your skin and nails until our next scheduled appoinment.

POST SERVICE QUESTIONS

Were you satisfied with our services during your visit? [ ] Yes [ ] No

If you weren’t satisfied, please feel free to explain your disatisfaction so that we can work
effortlessly on improving our service for you and other clients.

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

Is there anything we can do to resolve an issue you had? If you didn’t experience any difficulty,
is there any ideas, critiques or impromements you wish to bring to our attention?

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

Would you like to be contacted via e-mail/social media about any upcoming promotions and special
events?

[ ] YES [ ] NO

THANK YOU FOR CHOOSING US !!!