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New Guest Intake Form
***PLEASE READ BEFORE MOVING FORWARD***
Thank you for trusting me as your pedicurist and nail artist! Before you fill out the following intake form, you should have booked an appointment with me.
If for any reason you are sick, or have an open wound, pus, or blood coming the toenail/foot. Your appointment will be canceled until you are cleared to receive a pedicure.
Please be sure to read the following
Policies & FAQs
Please feel free to contact me at (323)538-5815
I look forward to servicing you!
Nysi <3
Follow me on IG to stay connected @nailsbynysi
* Indicates required question
Email
*
Your email
Are you a new or existing client?
*
I am a new client
I am an existing client
I am an existing client but haven't had your service in over 1 year
Full Name
*
Your answer
Phone number
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Address where service will be performed, please advise if location has stairs. (Type "spa" if you are not requesting mobile service)
*
Your answer
Type of parking
*
Spa location
Structure
Street
Driveway
Public Parking Lot or Street Parking$
Valet
MOBILE SERVICE ONLY
Do you have a reliable source of electricity/water and a place to dispose of water for your service(s)
Yes
No
Maybe
Clear selection
What service(s) would you like to receive? (Check all that applies)
*
Custom Wellness Pedicure (for clients with problematic ingrown, chronic cuticle or dead skin buildup)
Restorative Wellness Pedicure (Toenail Enhancements, this service will be provided based on integrity of nails at the discretion of nail tech)
Luxury Gel Pedicure (callus removal, scrub, oil massage and foot facial)
Meticulous Pedicure
Basic Waterless Pedicure (no spa upgrade)
Gel Manicure
Manicure (Dry)
Nail Enhancements
Foot Soak
Required
Choose your color(s). You may choose up to 3 colors aside from black, white, and nude. If you have nail fungus this will not be applicable to you.
White
Black
Red
Nudes
Pink
Orange
Purple
Green
Brown
Blue
Yellow
Seasonal
Other:
Choose your design add-on(s).
Marble
Glitter Press
Encapsulation
Bling/Rhinestones
French Tip
Abstract
N/A
Other:
Do you have any of the following health conditions?
*
Foot sores, scabs or plantar's warts
Diabetes or Neuropathy
Ingrown Toenails
Fungal Infection
Hepatitis A or B
HIV/AIDS
Cancer
Other:
Required
If you have an ingrown toenail, are you experiencing any of the following:
Redness, stinging, stabbing pain in the toe, inflammation, swollen toes. If so, please send a picture of your toenails by text message to my business line: (323) 538-5815.
Do you have any physical limitations, allergies, or any other health concerns I should know about?
Questions and comments
Your answer
Please
type
your
name
and
today's date.
By e-signing this form you agree that you have read the policy, and have truthfully and accurately answered all of the above questions.
*
Your answer
*
MM
/
DD
/
YYYY
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