Consultation Form

HEALTHCARE QUESTIONS

Do you have Diabetes? (required)
YesNo

Do you have Hep A/B/C? (required)
YesNo

Do you have Varicose Veins? (required)
YesNo

Do you have Cancer? (required)
YesNo

Do you have Psoriasis? (required)
YesNo

Do you have Eczema? (required)
YesNo

Do you have Bone Problems? (required)
YesNo

Do you have Long COVID? (required)
YesNo

Do you have Hypo/Hyper Thyroidism? (required)
YesNo

Do you have Allergies? (required)
YesNo

Do you smoke? (required)
YesNo

Do you have any Fungal, Viral, Bacterial, Parasitic Infections? (required)
YesNo

Are you/Do you suspect that you may be pregnant? (required)
YesNo

Have you recently undergone any surgical procedures in the past 5 years? (required)
YesNo

Are you on any medication? (required)
YesNo

Do you have any cuts, wounds, bruising, or swelling on your hands and arms or feet and legs? (required)
YesNo

If you have ticked 'yes' to any of the above, please explain in more detail below.

Describe the condition of your natural nails below. For example: strong and healthy, weak and brittle, do they have ridges, are they splitting, peeling, cracked, yellow, separating from nail bed etc.

Describe the condition of the skin around your nails. i.e. dry, inflamed, sore, open wounds, hangnails, infected etc

Please state below any specific concerns you may have regarding your upcoming appointment below

LIFESTYLE

How would you describe your activity level?

Do you practice nail/foot care at home? If yes, please state below your routine and which products you use

Do you maintain your mani/pedi regularly? If yes, how often?

Are you aware that certain lifestyle factors can impact the longevity of your manicure or pedicure?