Name
*
Email
*
Phone
*
Guest's Name
*
Are there specific issues you would like the nail technician to be aware of:
*
Thick/brittle toenails
Calluses
Heel Cracking
Itching/burning in your feet
Cold feet/poor circulation
Neuropathy/nerve conditions
Pain in the feet or legs
Toenail fungus
None of the above
Do you have any of the following conditions?
*
High blood pressure
Heart issues
Rashed to your feet or legs
Diabetes
Blood clotting issues
Spasms or cramps in your feet or legs
Varicose veins
Thin skin
Neuropathy in feet or legs
Arthritis in feet or legs
Seizures
Significant low back pain
None of the above
Are you pregnant or nursing?
*
Yes
No
Are you taking any medications or supplements at home? If yes, please list:
List any allergies that may affect your service:
Pure Peninsula Spa Policy
*
I have read this document and accept the terms as indicated above.
Pure Peninsula Spa COVID Release Policy
*
I have read this and accept the terms as indicated above.
Schedule Appointment