Consent and waiver

The form every client signs before service.

Print it, or save it as a PDF from your phone's share menu. A family member or power of attorney may sign for a resident.

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Mobile Nail and Toe Services: Client Consent, Waiver and Policy

Banana Bear Acrylics · Licensed Nail and Toe Technician · Roswell, NM · 575-805-3900

1. Client information

Name Date

Phone Address of service

Emergency contact

2. Health disclosure (required)

Check all that apply:

  • Diabetes
  • Poor circulation or neuropathy
  • Blood thinners
  • Immune disorder
  • Fungal or bacterial infection on nails or feet
  • Allergies (latex, acrylic, fragrances)
  • Pregnant
  • Recent surgery or injury to hands or feet
  • Other:

I understand the technician may refuse or modify services, especially pedicure or toe services, if a condition presents a safety risk, and may refer me to a medical professional.

3. Consent and assumption of risk

I voluntarily consent to mobile manicure, pedicure and nail enhancement services. I understand risks include but are not limited to allergic reaction, skin irritation, chemical burn, cuts, infection, lifting or breakage, and damage to natural nails. I have disclosed my health conditions truthfully.

4. Liability waiver and release

To the fullest extent permitted by law, I release the technician and Banana Bear Acrylics from liability for any adverse reaction or injury arising from services, except in cases of gross negligence or willful misconduct. I agree I am responsible for following aftercare instructions.

5. Mobile service policy

  • Travel. Based in Roswell, NM. Service available as far as Ruidoso, NM. No travel fee within Roswell. Outside Roswell, a flat $40 travel fee per visit, separate from the service price.
  • Deposit. No booking deposit is required at this time.
  • Setup. The technician provides her own table, tools and sanitation kit. The client provides chairs and adequate lighting next to an outlet. If the space is not workable on the day, the technician may reschedule.
  • Cancellation. Please give at least 24 hours notice. No cancellation or no-show fees are charged at this time.
  • Payment. The full balance is due at the appointment by card or cash.

6. Right to refuse service and respect policy

This is a respectful, comfortable space for both of us. If at any point the technician feels uncomfortable or harassed, she has the right to refuse service, stop and leave. In such cases, payment for services already rendered is non-refundable.

7. Sanitation notice

All implements are disinfected per New Mexico Board of Barbers and Cosmetologists rules. Single-use items (files, buffers, pedicure liners) are disposed of after each client. Portable pedicure basins use disposable liners, one per client.

8. Photos

  • I consent to photos of my nails for portfolio or social media (no face or identifying information without separate permission).
  • I do not consent to photos.

9. Signatures

Client signature (or authorized representative) and date
Technician: Brianna Medina, and date

Ready when your residents are.

Call or text Brianna to set up a visit. No deposit, no travel fee in Roswell, and nothing to pay until the day.

Call 575-805-3900 Text Brianna