Blush Nail Studio

Intake

This form completes your treatment file. We only ask what is needed to treat you safely. Your answers go directly to the studio and nowhere else, and are kept according to the retention period in the privacy statement.

Name *

E-mail address *

Phone number *

Date of birth *

Address

Desired treatment *

Have you had this treatment somewhere else before?

Health

Answer every question with yes or no. A yes does not automatically mean the treatment cannot go ahead; we discuss it together.

Do you have diabetes?

Do you have circulation problems?

Do you have nail fungus or psoriasis?

Are you allergic to acrylate or HEMA?

Are you pregnant?

Do you take medication?

Have you had artificial nails before? If yes: when were they removed?

Is there anything else I should know?

I have read and understood the information about the treatment, healing and aftercare, and consent to the treatment. Read more here.

I give explicit consent to keep the health details from this form for my treatment file, 5 years after my last treatment. Read more here.

Photos of my treatment may be used anonymously for portfolio and social media.

I would like to receive occasional tips and news by e-mail.

Signature

Full name (typed) *

Date: 16/09/2026