EmailMe Form - Consultation Form

Name *

First Last

Birth Date

MM / DD / YYYY

Allergies *

Yes

No

If yes, please list to what:

Examples: Latex, etc.

Health Conditions *

Foot Condition *

Are you pregnant? *

Yes

No

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

Yes

No

Preferred Length

Short

Medium

Long

Preferred Nail Shape

Preferred Nail Service

Polish

Gel Polish

Preferred Nail Color

Have any problems with

Nail Biting

Hangnails

Chipping Nails

Did someone refer you? If yes, who?

Standing Appointment?

Best Days

Best Time

HH : MM AM/PM