Survey (Consumer)

(Consumer)
Survey for Dermatological Pathology caused by:

Responses to the survey are optional/confidential.

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1. As a consumer of pedicure services, acrylic nails, facial peels or manicure services, have you ever been injured,
received an infection or developed a skin reaction by the salon industry:

Yes No

2. If you would like to receive updated medical information about the nail industry, please complete the following:

First Name:		Last Name:
Street Address:		City:
State:		Zip Code:
Phone Number:		Fax Number:
Email Address:

3. If you have been ever been injured, received an infection or developed a skin reaction as a result of receiving services
at a salon what kind of problems did you receive:

(Mark Any or All)

Fungal Nails

Bacterial Infections (such as pseudomonas or "Greenies" from acrylic nails or Mycobacterium infections
from whirlpools)

Staph Infections or other bacterial infections from a cut received during pedicure or manicure service

Skin problems or allergies due to chemicals or damage from exfoliation during a facial or skin peels

4. Have you received medical treatment for, or are currently being treated for, any injuries, infections or
conditions which you believe you received from a salon:

Yes No

If so, what kind of doctor treats you for these problems:

5. Have any of your friends ever received an infection from a nail tech's service such as:

(Mark any or All)

Fungal Nails

Bacterial Infections (such as pseudomonas or "Greenies" or mycobacterium infections)

Staph Infections or other bacterial infections from a cut received during pedicure of manicure service

Skin problems or allergies due to chemicals or damage from exfoliation during a facial or skin peels

Allergic reaction to acrylics nails

Allergic reaction to chemicals

Sick from breathing vapors

6. Does your nail tech inform you about potential hazards with the services they provide including (acrylic nail allergies,
whirlpool bath cleanliness, problems about nail salons in the media, dangerous chemicals fungal nails or nail infections):

Yes No

7. Does your nail tech review or keep a written list of your information:

Yes No

If yes, what information is on record:

(Mark any or All)

Name & Address

History of Medical Problems

Contact Numbers

Name of their personal Physician

Dates of Appointments

8. Are you satisfied with the level of cleanliness of services you receive from your salon:

Yes No

9. Do you notice if your nail tech cleans their whirlpool chairs:

Yes No

10. When does the nail tech clean the chair:

(Mark any or All)

At the end of each day

The end of each week

Between clients

11. Do you know how your nail tech cleans the surfaces of your pedicure/whirlpool chairs:

(Mark any or All)

Bleach	Hand Soap
Antibacterial Soap	Detergents
Alcohol	Tile Cleaners
Commercial cleaners

12. Would you like to see better rules and regulations coming from your state cosmetology board:

13. Would you like to see a medical specialist become a member of your state cosmetology board to review health
related nail salon problems, or to ask questions regarding what medical issues in nail salons affect the general public:

Yes No

14. Do you believe the nail tech's method of sanitation is adequate to protect the public:

Yes No

15. Have you ever seen your nail tech use the same instruments on more than one person without being
sanitized between uses:

Yes No

If yes which one? (Mark any or All)

Pumice Stone	Nail File
Nail Clippers	Wax
Cuticle Sticks	Cuticle Nippers

16. Do you provide your own a nail nipper, nail file, or cuticle stick to make sure you have clean instruments:

Yes No

If yes which one? (Mark any or All)

Nail Nipper	Nail File
Chemical Peel	Cuticle Remover
Acrylic nail application service

17. Do you share a nail clipper with any of your family members:

Yes No

18. Do you believe the salon industry should sterilize their instruments:

Yes No

19. Does your salon have a ventilation system to protect you and other clients:

Yes No

20. Do you believe the salon beauty industry should do more to protect the general public from bacterial, viral or fungal
infections in the salon:

21. Does your nail tech sell products in your salon to treat the “Greenies”, fungal nails, nail problems, or skin problems:

Yes No

If yes, what kind of products does she sell:

(Mark any or All)

Cuticle Oils	Nail Polish	Antibacterial Drops or Creams
Antifungal Drops or Creams	Nail Cleaner	Facial Peels
Shampoos	Hair Products	Skin Lotion/Oils

What is the brand name of the products or major companies who sell these products: Unknown

(Enter your comments below)

22. Do you believe that nails techs would benefit by required continuing education credits to improve their knowledge base
or learn how to improve their services:

Yes No

23. Would you go to a nail salon if it was certified by a physician using only fresh packs of sterilized instruments or
other advanced certifications?:

Example: A spa called Physicians Nail Spa

Yes No

24. Have you ever checked on a salon’s history of citations with your state’s cosmetology board:

Yes No

25. What do you believe is the most important change you would like to see in this industry:

(Enter your comments below)

If you do not submit the survey online, Please email at: rts9999999@aol.com

(and I will fax you a survey to fill out) Phone: 423-756-3668

Fax: 423-886-1142

Dr. Robert Spalding

1225 Taft Hwy

Signal Mtn, TN 37377