digital spa waiver form - WaiverElectronic

Nail Services Waiver Form

Welcome to Nancy Taylor Day Spa
We are committed to providing you with unparalleled services and products. Please complete the following form as thoroughly as possible to help us achieve this goal.
Thank you for choosing Nancy Taylor Day Spa. It is our pleasure to serve you.

Please fill your name: *

Please enter your full name.

Date of Birth: *

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Please fill in Address: *

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Email: * Please enter your email.

Phone number: * Please enter your phone number.

How did you hear about us? Please enter your answer here.

Please list any medications you take or use (include oral, topical, blood thinner, pain reliever, etc.) Please enter your answer here.

Do you have any known allergies? (food, medicine, environment, etc.) If yes, please explain: Please enter your answer here.

Are you a diabetic? Please enter your answer here.

Have you ever been diagnosed with an infectious disease? If yes, please explain. (i.e. HIV positive, Hepatitis A or B) Please enter your answer here.

Are you pregnant? Please enter your answer here.

Have you ever had a nail fungus? Or, do you currently have a nail fungus? * Please enter your answer here.

THE SPA RESERVES THE RIGHT NOT TO SERVE A CLIENT DUE TO DISEASE OR POTENTIAL CONTAMINATION OF THE SERVICE AREA. THE SPA ALSO RESERVES THE RIGHT TO CHARGE FOR APPOINTMENTS CANCELLED OR NO SHOW WITHOUT 24 HOURS NOTICE. DUE TO THE POTENTIALLY HAZARDOUS CHEMICALS, PLEASE NO CHILDREN UNDER THE AGE OF 13. CLIENTS WILL BE RESPONSIBLE FOR INFORMING THE NAIL TECHNICIANS OF ANY CHANGES TO THIS FORM.

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Signature Date *

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