Name

Address

Mobile Number

Occupation

Do you have any hobbies which involve working with your hands?

Do you participate in sports?

How many hours a week do you spend caring for your hands and feet?

How frequently do you have professional nail services?

Skin Type

Cuticle

Nail Length

Shape

Doctors Name

Doctors Address

Telephone Number

Are you Diabetic

Asthmatic

Do you have any allergies (please state)

Undergoing any medical treatment or have any known conditions, please provide further details

Do you wear contact lenses

Any Contra Indications, please give further details

Length Required

Shape Required

Finish

Product Supplied

I confirm that I understand these details are provided for the sole purpose of maintaining this record card. I can confirm that I understand the treatment that is to be performed and that I have been instructed on the correct use of rubber gloves, cuticle oil, nail polish removal and extension removal and understand my nail technicians recommendations.

I confirm I am over the age of 16. Treatments may still be possible if you are not over the age of 16, please however contact us first.

I am happy to receive special offers and information from Amora Nail & Beauty in the future, your details WILL NOT be passed onto any other companies.