NAME *

First Name

Last Name

PHONE *

(###)

###

####

ADDRESS OF SERVICE *

Please share the address that you wish us to service below:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

MEDICAL DISCLOSURE *

Do you have any medical issues and/or conditions we should be aware of during service?

Diabetes

Thickened toenails

Open wounds

Fungus

Green or yellow toenails

Nail lifting

None

TERMS & CONDITIONS *

I agree to the following terms and conditions... We provide Mobile Nail Services for your convenience. Please note, we reserve the right to require greater service minimums and/ or a travel fee/surcharge for service locations that are within our extended service area, but outside of our standard service area. EXCESS/WAITING FEE Please be mindful that we have other clients scheduled after your appointment so its important that we are able to start on time. Otherwise, the service may have to be rushed/shortened and/or all services may not be able to be complete, in which case a refund will not be given. SAFETY For your safety and ours, we ask for enough disclosure be given at the time of booking your appointment regarding any medical issues and/ or conditions you or the person you are booking on behalf of may have. If we arrive and are unable to provide services for any of these reasons, we reserve the right to refuse service and a refund will not be issued.

Yes

COVID SAFETY *

Prior to the start of my service, I confirm that: *I have not been diagnosed with or cared for someone diagnosed with COVID-19 in the past two weeks *I have not shown symptoms of COVID-19 or come in close contact with anyone exhibiting these symptoms in the past two weeks *I do not have a cough- fever-chills-shortness of breath or loss of taste or smell *If I begin to show symptoms of COVID-19 within the next two weeks I will contact “Pamper Me” Mobile Nails & Spa. *I will follow all COVID safety protocols to keep myself and those around me safe.

Yes

No