EmailMe Form - Consultation Form

Name *

First Last

Email *

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Birth Date

MM / DD / YYYY

Allergies *

Yes

No

If yes, please list to what:

Examples: Latex, etc.

Health Conditions *

Name Of Your Physician

First Last

If other, please list what:

Examples: Edema, etc.

Foot Condition *

Name Of Your Podiatrist

First Last

Are you pregnant? *

Yes

No

Are you taking any blood thinning medication (Ex., aspirin) ? *

Yes

No

Are you currently wearing nail wraps, gel or acrylic in need of removal? *

Yes

No

Preferred Length

Short

Medium

Long

Preferred Nail Shape

Preferred Nail Service

Polish

Gel Polish

Dip Nails

Acrylic Nails

Preferred Nail Color

Have any problems with

Did someone refer you? If yes, who?

Standing Appointment?

Weekday Availability

Best Time

HH : MM AM/PM

Social Preference

Talk Time

Silent Appointment (Client Or Tech May Still Talk On Phone)

Whatever Happens, Happens

Favorite Music Genres

Rap
Hip-Hop
R&B
Reggaeton
Gospel
Soul
CCM
Pop
Salsa
Bachata
Instrumental
Lo-Fi