New Client

Health & Allergy Intake Form

Please complete this form before your first appointment. Your health and safety is our top priority.

        All information provided is kept strictly confidential and used solely to ensure your safety and comfort during your nail appointment. This form is protected under POPIA.
    

Personal Details

First Name *

Last Name *

Phone Number *

Email Address

Date of Birth

Allergies & Sensitivities

Do you have any known allergies or sensitivities? *

No known allergies Yes, I have allergies

Have you ever had an adverse reaction to nail products?

No Yes

Nail History

Have you had nail enhancements before?

No — first time Yes

Do you currently have any nail product on your nails?

No Yes — gel Yes — acrylic Yes — polygel Yes — nail polish

Do you have any nail concerns we should know about?

Consent & Declaration

By submitting this form I confirm that the information provided is accurate and complete to the best of my knowledge. I understand that withholding relevant health information may affect the safety of my treatment.

I confirm that the health information provided above is accurate, and I understand that Pearly Nails Studio may use this information to safely perform my nail services.

I consent to Pearly Nails Studio photographing my nails for portfolio and social media purposes. (Untick if you prefer your nails not to be photographed.)

I consent to Pearly Nails Studio collecting and storing this information in accordance with the Privacy Policy and POPIA. I understand I may request deletion of my information at any time.

Thank you! 💕