Nails - self.

Nail Consent Form

Please read the information below and fill out your personal consent declaration.

Full Name

Date Of Birth

Age

Address

Post Code

Phone Number

GP Surgery

HAVE YOU EVER HAD A NAIL INFECTION?

Yes No

HAVE YOU EVER HAD AN ALLERGIC REACTION?

Yes No

DO YOU TAKE ANY MEDICATION?

Yes No

ARE YOU PREGNANT?

Yes No

DO YOU SMOKE?

Yes No

DO YOU DO A LOT OF WORK AROUND YOUR HOME?

Yes No

DO YOU USE HAND LOTION?

Yes No

DO YOU HAVE ANY SKIN CONDITIONS PERTAINING TO YOUR HANDS OR FEET (PSORIASIS OR ECZEMA)?

Yes No

DO YOU HAVE ANY BROKEN SKIN?

Yes No

DO YOU PLAY ANY SPORTS THAT TAKE A TOLL?

Yes No

DO YOU HAVE HISTORY OF PICKING OR BITINGAT YOUR NAILS OR CUTICLES?

Yes No

I have read the information and if I have any concerns, I will address these with my therapist. I give permission to my therapist to perform the procedure we have discussed, and will not hold her or her staff liable for any adverse reaction to the treatment. I have given an accurate account of the questions asked including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my aesthetician will take every precaution to minimise or eliminate negative reactions as much as possible.

Dateof appointment

*Check Junk Mail For Your Copy*