Name & Surname Address Email Phone In order for us to give you the best nail service please answer the following questions: If you work, what type of duties do you perform on a daily basis? Do you do a lot of work around your home such as cooking, cleaning or gardening? Please explain: How many children do you have, and what are their ages? 4. Do you take part in any athletic activities? If so, what are they and how often do you exercise? Are you taking any medication, whether prescribed or over the counter? YES/NO Please explain: Do you have or had history of the following? Thyroid Problems Allergies Circulatory Muscular Disease Diabetes Cancer Hypertension Other Explain Other? What treatment has been prescribed? Are you pregant? YES/NO (kindly note if your answer is yes, it will be an additional charge of R200.00 extra) How far are you? Are you lactating? Yes No Are you currently under any type of excessive stress? Yes No Don't Know Do you spend time on your nails? Always Sometimes Rarely Never Do you have a history of biting or picking at your nails or cuticles? Always Sometimes Rarely Never Is your Skin? Normal Dry Oily Combination Have you always worn nail polish with your enhancements? Always Sometimes Rarely Never Would you like the option to wear a permanent French Manicure? Yes No Would you like the option to wear a permanent French Manicure? Yes No If you prefer to wear enamel, what is your favorite color? What day is the best day and time for your appointment? Do you agree to keep a regular appointment schedule to maintain your nail enhancements? Yes No Don't Know Digital Consent Coco Vogue reserves the right to charge for appointments which has not been cancelled within 24 hours in advance. due to hazardous chemicals in the salon please make other arrangements for your children on appointment days. Coco Vogue will not be held laible for injury of accidents to or Date caused by unsupervised children. Send