Multiple Service Form

Some services are not eligible for gift certificates/ Vouchers, payment will be required before through payment link for services can. Be accessed in your customer panel, link will be sent in email after form is filled out and appointment is approved. Please also be aware you cannot decline an already booked service extra The Day Of The Appointment. What is booked and blocked out is what the services and payment due that day.


Click or drag files to this area to upload. You can upload up to 4 files.
These pics can be from anyone it doesn’t have to be from my specific social media, also to make searching easier when searching ‘simple’ gets more search results, Example: Pink nails, Cateye nails, Luminary nails Instagram has great inspo, Valentines nails, Spring nails, Almond nails

I am not knowingly suffering from any infection or disease at the time of treatment. I understand that some medication may contradict my treatment. CLient is responsible for my nails outside of the salon, this includes pulling weeds without gloves, coming into contact with fecal matter, not washing hands and other practices they may encourage bacteria or infection with the hands and feet.

Click or drag files to this area to upload. You can upload up to 4 files.
If you have polish or any system off please soak off and not tear off system, having a system on will not give me a clear look of what we’re working with, for legal and insurance purposes I will NOT work on extremely damaged nails/ any infections/ I also legally do not work over any nail techs product or system that isnt mine or take off anyone else’s work. If you are a nail model please disregard an please just upload the state of the nails.


By signing below, you attest that you have provided accurate and current information on this form and answered all medical and health-related questions truthfully and completely. Your signature also certifies that you understand that Polishbyjess LLC reserves the right to deny service to any client due to a health condition he or she has that may pose a potential risk to practitioners or other clients, including those that pose a risk of potential contamination to service areas. Furthermore, signing below verifies that you understand that you are responsible for informing Polishbyjess LLC and/or its the technicians of ANY and ALL changes to your health condition as regards any question on this form or any potential public health risk that may arise from any change in your health condition.



Please be aware before moving on to the questions, any type of injectables surgery, or passed head trauma or in the face will need more treatments to retain these areas again. Especially if you have certain injectables or threading. Please be aware the machine can go as high as it goes but that is not our goal in retraining the muscles, that is like lifting bench pressing 300 pounds the first time you work out, no good.
Topical steroid: We suggest not to treat patients using topical steroid. ● Thyroid Condition: Consult your physician if you or your client is suffering of either hyper or hypo thyroidism. ● Current history of skin cancer or any other current condition of cancer or premalignant moles ● Diseases which may be stimulated by heat such as recurrent herpes simplex in the treatment area may only be treated following a prophylactic regimen ● History of any type of cancer not cleared by the client’s doctor ● Don’t treat over a tattoo or permanent make up ● Impaired immune system due to immunosuppressive diseases such as HIV, AIDS, or use of immunosuppressive medications ● Poorly controlled endocrine disorders such as diabetes ● Any active condition in the treatment area, such as sores, psoriasis, eczema or rash ● Any surgical procedures in the treatment area within the last 3 months ● No pregnant or Lactating clients should be getting Radio Frequency ● For injections wait the following time periods ● Neurotoxin injections wait 3-4 weeks, can be done beforehand ● Natural Fillers ( EX. Hyaluronic Acid, Collagen etc.) wait 3-4 weeks, can be done beforehand. ● Synthetic Fillers (EX Silicone) DO NOT treat the area, can do beforehand ● Pacemakers ● Others: We suggest not to treat patients with current medical treatment that involve the following: cortisone, steroids treatment, and photosensitive drugs and herbs such as psoralen and St. John’s wort. It is recommended to consult with dermatologist in case it is not possible to identify a skin condition or if you are uncertain about a diagnosis you have received. Most people experience no side effects, some may show some short-term local reddenin which goes away within 15-20 minutes

Thermal Rejuvenation AKA RF


Please be aware contact lenses are not suggested for wearing at time of appointment, Medication use, Skin conditions etc by manufactures rules, also these are the basics pre-op appointment questions to ask by the manufacture themselves, if there is any added info about your eyes I must know before please let me know.

Liability Release

You agree to the following terms by signing below: I am over the age of 18 and agree to this agreement and treatment. I have filled out this form truthfully and to the best of my ability. I agree to notify the technician if any of the above information changes. I agree to release my technician from all liability for any injury or damage caused by any misrepresentation.

Florida Statues Title XXXll Chapter 477.013 Board of Cosmetology

Here in the state of Florida, it is required to be licensed and insured, within the laws and regulations of chemical services in the state of Florida, My establishment is licensed under Body Works Insurance.
If you clicked yes, please continue filling out the form and I will contact you shortly. If you have clicked no, you are also agreeing to release all prosecution and fines or any other legalities.

Release of liability:

You accept the following by signing the form below I agree to this contract and the procedures. This has been filled out honestly and to the best of my knowledge. I consent to update the technician on any changes to the previously provided information. I consent to disclaim all liability. to the technician for any harm or damages brought on by any misrepresentation.