Client Consultation Form

Please copy and paste this form to a new email, complete and send to elegancenailsbysarah1@gmail.com

Welcome to Elegance Beauty Studio.  

I aim to ensure clients have the best possible advice both prior to and post-treatment. I ask you to familiarise yourself with the contra-indications and aftercare advice that applies to your treatments. Along with reading the terms and conditions. 

Please complete and sign this form and return before your first appointment, preferably a minimum of 2 days before. If you answer yes to any of the questions, please give further information.

 

Personal information  

For data protection your information will not be passed on to anyone else and is only for Sarah Hall’s use. Your information will permanently be deleted after 5 years from your last appointment.  

First & Last name:  

Date of birth & age:  

Full address:  

Phone number:  

Email address:  

What is your occupation:  

 

Medical History

GP surgery and phone number:  

Emergency contact name, number and relation:  

What medication are you taking at the moment? 

Do you have any allergies? (Please note that some treatment products may contain nut oil. Any allergies must be disclosed prior to treatment).  

Have you had any previous reactions to beauty treatments or products? e.g. nail products, wax, hair dye or tint, makeup or skin products etc.  

Have you had a high fever/severe illness in the past 2 weeks?   

Are you due to or have you undergone any surgical procedure?   

Are you pregnant or have you given birth in the last 6 months? If yes, please give due/ birth date.  

Are you a smoker?  

How often do you drink?

Do you have any special concerns you would like to discuss?  

 

Nails  

Are you currently using or applying products to your nails?  

When was the last time you had a professional nail service? 

Have you ever had a nail infection?  

Do you wear gloves if you clean the house, do the gardening, or washing dishes? 

Are you aware hand lotion can cause nail products to lift? Avoid hand creams and skincare products that contain lanolin, mineral oil as these melt the bond and lift the gel.  

Do you have any skin conditions on your hands (e.g. psoriasis, eczema etc.)?  

Do you have any injury to your hands? Including broken skin, small cuts/ scratches.  

Do you do any activities/ sports etc. that may cause damage or breakages to nails?  

Do you have a history of biting or pick your nails and or cuticles (skin around the nail)?  

Is there any other information you feel is important for your therapist to know or may impact your treatment during or after it has been done?  

To be completed by Beautician, Sarah Hall  

Nail condition e.g. split S, peel P, crack C 

Rp     Rr     Rm     Ri     Rt   

 

Lp     Lr     Lm     Li     Lt   

Cuticle condition e.g. dry D, torn T, inflamed I 

Rp     Rr     Rm     Ri     Rt   

 

Lp     Lr     Lm     Li     Lt  

 

Eyebrow & Eyelash Tinting  

Have you used hair dye or colour before?  

Have you had your lashes or brows tinted before?  

Do you wear contact lenses?  

Any eye problems in the last 4 weeks?  

Do you use any eye products?  

Type of eye makeup and mascara you use?  

Do any of the following apply to you:  

• Stress   
• Seasonal Allergies   
• Lumps/Cysts  
• Eye Surgery  
• Alopecia   
• Cold Sores around Eyes  
• Permanent Eye Make-up   
• Hormonal Imbalance   
• Psoriasis  
• Diabetes   
• Hypersensitive Eyes   
• Pink Eye  
• Blepharoplasty   
• Thyroid Diseases  
• Sty of the Eye  

Is there any other information you feel is important for your therapist to know or may impact your treatment during or after it has been done?  

To be completed by Beautician, Sarah Hall

Date of patch test:  

 

Waxing

Have you been waxed before?  

Do any of the following apply to you:

• Diabetes 
• Oedema 
• Psoriasis/ Eczema  
• Sunburn  
• Moles  
• Pregnancy   
• Scar tissue (6 months minor operation or 2 years major operation) 
• Undiagnosed lumps or bumps  
• Epilepsy or non epileptic attack disorder  
• Phlebitis  
• Poor circulation  
• Varicose veins  
• Skin disease  
• Hypersensitive skin  
• AIDS/ HIV  
• Hepatitis  
• Cancer  
• Cold sores  
• Folliculitis  

Are you taking any medications that make you photosensitive?  

Are you taking blood thinners?   

Do you use any of these products?  

• Retin A 
• Differin  
• Renova 
• Glycolic acid  
• Accutane  
• Oedema  
• HRT  
• Rowacitane  
• Steroids  

Will you refrain from being sunburnt or using a tanning bed within 24 hours of this treatment?  

Do any of the following apply to you:

• Ingrown hairs  
• Scarring  
• Bumps  
• Hyperpigmentation  
• Bruising  
  

Is there any other information you feel is important for your therapist to know or may impact your treatment during or after it has been done?  

Massage

How would you describe your stress levels?

How would you describe your energy levels?

Do you exercise regularly?:

Have you ever received a massage treatment before? 

what kind of massage pressure would you like?

Do any of the following apply to you:

• Unstable blood pressure 
• Osteoporosis
• Heart disorders
• Epilepsy 
• Thrombosis/embolism
• Diabetes 
• Skin Disorders
• Arthritis
• Recent haemorrhage
• Inoculations 
• Back Problems
• Fever 
• Swelling/Oedema 
• Dysfunction of nervous system (eg MS) 
• Have you ever had or do you have cancer 
• Do you have any recent fractures or sprains
• Any infectious diseases
• Any allergies – ie to nuts, essential oils
• Any bruising, cuts, abrasions, varicose veins
• Recent surgery, broken bones, scarring
• Recently consumed alcohol
• Recently consumed a heavy meal
• Other conditions (eg ME) 

Makeup  

What is the occasion for your makeup appointment?  

What type of makeup look are you aiming for? Please be specific, send photos of the acquired look.   

Will you have had recent surgery or dermabrasion?  

Will you have had any type of chemical or glycolic peel?  

Will you have self-tanned in the 24 hours prior to your appointment?  

 Skin tone:  

• Pale skin  
• Fair skin  
• Medium skin  
• Olive skin  
• Naturally brown skin  
• Very dark brown or black skin  

 Skin Type:  

• Normal - smooth skin, balance of oil and moisture, infrequent blemishes 
• Combination - smooth skin, oily t-zone and dryness on outer edged face  
• Oily - large pores and shines in appearance  
• Sensitive - redness and allergic reactions  
• Dry - small pores/ dull in appearance. Little or no oil or shine  

How often do you wear makeup?  

• Daily  
• Special occasions  
• Never  

Is there any other information you feel is important for your therapist to know or may impact your treatment during or after it has been done?  

Spray Tan

Do any of the following apply to you:

• Open wounds
• Pregnancy
• Allergies
• Asthma
• Verruca’s
• Eczema 
• Epilepsy
• Cold Sores
• Rashes 
• Psoriasis
• Sunburn
• Recent Scars 
• Conjunctivitis
• Impetigo  
• Ringworm 
• Burns 

Are you on any medication taken orally or applied topically?

Have you had a recent Skin peel, Microdermabrasion or are you using Glycolic based

skincare?

Have you had any recent filler injections?

What Kind of Tan / Colour would you like to achieve?

Have you used self tanning products before? If yes, what was the outcome and were you

happy?

Declaration

I agree the information I have given on my consultation form is accurate and to the best of my knowledge. I accept that failure to disclose relevant information may impact treatment results. I agree to update the therapist of any changes to my circumstances in the future. I have read and understood the relevant contra-indications and aftercare advice. I agree with the terms and conditions.  

Signed:

Dated: