Consultation Form - Luna Moth Cottage

First Name *

Last Name *

Email Address *

Phone *

Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

What are your favorite colors? Feel free to select multiple.Warm colors (ie. reds and oranges)Cool colors (ie. blues and greens)Warm neutrals (ie. cream, brown, gold)Cool neutrals (ie. white, grey, black, silver)Jewel tones (ie. emerald, ruby, sapphire)NeonsPastels

Do you have any allergies? *YesNo

If yes, please list them below.

Have you ever had a negative reaction to any nail products? *YesNo

If yes, please describe the reaction and what product caused it.

Do you have any nail/hand/foot concerns that you'd like to be addressed? Or is there something that you'd change about your nails if you could?

Photo/Video Consent: *I consent to the use of photographs and/or videos of my hands or feet for promotional purposes.I do not consent to the use of photographs and/or videos for promotional purposes.I understand that I can consent or refuse the usage of photographs and/or video footage of my hands or feet taken during the service provided by Luna Moth Cottage. I understand that these images and videos will be used for promotional purposes on social media platforms and the YouTube channel “Luna Moth Nails,” and no voice recordings will be used in the social media or YouTube posts and my face will not be visible.