Name *

First Name

Last Name

Phone Number *

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date Of Birth *

MM

DD

YYYY

Doctors Phone Number *

Country

(###)

###

####

Do you have any medical conditions? *

Yes

No

Are you or have you been on any medications in the last 6 months? *

Yes

No

Do you have any allergies including to any beauty products / beauty treatments / any other products? *

Yes

No

Are you pregnant? *

Yes

No

PHOTOS - Do you agree to NAIL BUS LTD using photos of your before or after treatment for marketing (social media / website, etc..)? *

Yes

No

I declare that the information I have given is correct and I have not withheld any information. I will inform NAIL BUS LTD of any changes to my Client Form. *UNDER 16 - Please see terms & conditions below. *

I have read and agree to the terms and conditions above

I am over 16 years

Date *

MM

DD

YYYY

UNDER 16 - Tick above to agree to the terms & conditions, print full name and date. PARENT / GUARDIAN.- Consent to treatment for above named minor, agree to terms & conditions and check all Client Form details provided are correct.

I PARENT / GUARDIAN give full consent to above named minor receiving treatment(s) at NAIL BUS LTD

I PARENT / GUARDIAN have read and agree to the terms & conditions above

I PARENT / GUARDIAN confirm the Client Form details provided are correct

Date

MM

DD

YYYY