Pedicure Appointment

top of page

ChatGPT Image Jul 12, 2026, 06_34_52 PM.png

Pedicure Intake

First name

Last name

Phone

Foot / Nail check

If yes, please explain:

Have you recently had a foot, skin, or nail infection?

Yes

Not Sure

Health & Safety

Are you currently pregnant?

Yes

Do you have diabetes?

Yes

Do you have any condition that affects your feet, circulation, sensation, or healing?

Yes

If yes, please explain:

Do you have any allergies or sensitivities to nail or beauty products?

Yes

Not Sure

If yes, please list them:

Your Preferences

Is there anything you'd like your nail artist to know?

Client Aknowledgement

I confirm that the information provided is accurate to the best of my knowledge.

I understand that my nail artist may modify or postpone a service if there is a safety concern involving my feet, skin, or nails.

I understand that this form does not provide medical diagnosis or treatment and that I should consult a healthcare professional regarding medical concerns.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Book an appointment

October 2026

Week starting Sunday, October 18

Time zone: Coordinated Universal Time (UTC)Phone call

Tuesday, Oct 20

10:00 AM - 11:00 AM

11:00 AM - 12:00 PM

12:00 PM - 1:00 PM

1:00 PM - 2:00 PM

bottom of page