New Client Consultation | The Nail Designer™

GP name *

First

Last

Medical Practice Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Permission to contact your GP if required? *

Yes
No

Are or might you be pregnant? *

Yes
No

If yes, expected due date?

Are you taking any medication? If yes, please specify

Do you have any allergies? If yes, please specify

Do you have or have you suffered from any of the following? *

Anything you feel we should be made aware of?

Signature *

Clear Signature

GDPR / Privacy Agreement *

I consent to having The Nail Designer store my submitted information so they can respond to my enquiry.

Privacy Statement: Data Protection Act 1998 – The Nail Designer will control the data that you have supplied in your enquiry. The information you have provided will be processed for the purpose of internal administration. We will keep your data for 6 months from the date of your last correspondence with us. We will not share your data with anyone else. If you have any queries regarding data protection, please call +44 (0)7572 010368 and ask for the Data Protection Officer, or send an e-mail to ask@TheNailDesigner.co.uk