Reference Card
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Name: ____________________________________  Birthday: _________ |
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Address: ____________________________________________________ |
| City: ______________________________ State: ________ Zip: ________ |
Telephones:  Home: __________________ Work: __________________ |
| Email Address: ___________________@___________________________ |
| Scheduled Appointment Times: AM ____ PM ____ Day of Week: ________ |
Recommended Visiting Schedule: Weekly ____ x2 ____ x3 ____ x4 ____ |
| Polish Colors Preferred: _____________________ ____________________ |
| ____________________ ____________________ ____________________ |
| Date of First Visit: _______________ |
| Service(s) Performed: |
| Manicure: ___________ Pedicure: ___________ Heat Sculpt: ___________ |
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| Condition of Nails on First Visit: |
| Right Hand: | | ________ | ________ | ________ | ________ | ________ |
| | Pinkie | Ring | Middle | Index | Thumb |
| Left Hand: | | ________ | ________ | ________ | ________ | ________ |
| | Pinkie | Ring | Middle | Index | Thumb |
|
| Code: (M)Mold (F)Fungus (C)Cracked (P)Peeling (I)Infected (N)Nail Biter |
| Any Known Allergies: __________________________________________ |
| Condition of Hands/Feet: ________________________________________ |
| Special Services Suggested: |
| Manicure | _______
cost | Clear Overlay | _______
cost | French Sculpt | _______
cost |
| Polish | _______
cost | Nail Art | _______
cost | Nail Charms | _______
cost |
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| Suggestions for Client to Follow at Home: ____________________________ |
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