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Section 1 of 2: Client details

Personal Information

First name

Last name

Mobile number

Address

Section 2 of 2: Custom section

Covid 19

Following the COVID-19 pandemic, we’ve put extra measures in place for the safety of you and our staff members. We require all clients to fill in our COVID-19 Form before arrival so that we can provide the best possible and safe experience to our clients and staff members.

Please carefully read and answer the below questions. This information will be stored confidentially and securely by us.

If you or a member of your household has developed a cough, fever, breathlessness, sore throat or headaches within the 14 days, please contact us before your appointment so we can obtain further information from you and advise.

Please get in touch if you have any questions - we’re looking forward to welcoming you back.

Do you, or anyone in your household, have any flu-like symptoms?

Are you experiencing a cough?

Are you experiencing a shortness of breath?

Have you had a fever (above 37.5C degrees) in the last 14 days?

Have you had any close contact with anyone who has tested positive for COVID-19 in the last 14 days?

I have understood, read and completed this form truthfully to my knowledge.

I knowingly and willingly consent to having services at this business during the COVID-19 pandemic.

I confirm to my knowledge that I, my household or social bubble have not been in contact with anyone that has had symptoms of COVID-19 in the last 14 days or anyone who has been self-isolating.

I consent for the services to be carried out which involves a staff member of the team being in physical contact with me with less than 2 metres distance.

To prevent the spread of the virus and protect each other, I confirm that I will strictly follow the businesses guidelines.

If guidelines are not strictly followed, I understand that the business has the right to cancel the appointment with the full cost of the service being charged and any other paid costs being non-refundable.

I confirm that I release the staff member(s) performing the service and the business from any and all liability for the unintentional exposure or harm due to COVID-19.

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CONSULTATION FORM PREVIEW

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Personal Information

First name

Last name

Mobile number

Address

CONSULTATION FORM PREVIEW

Step 2 of 2

Covid 19

Following the COVID-19 pandemic, we’ve put extra measures in place for the safety of you and our staff members. We require all clients to fill in our COVID-19 Form before arrival so that we can provide the best possible and safe experience to our clients and staff members.

Please carefully read and answer the below questions. This information will be stored confidentially and securely by us.

If you or a member of your household has developed a cough, fever, breathlessness, sore throat or headaches within the 14 days, please contact us before your appointment so we can obtain further information from you and advise.

Please get in touch if you have any questions - we’re looking forward to welcoming you back.

Do you, or anyone in your household, have any flu-like symptoms?

Are you experiencing a cough?

Are you experiencing a shortness of breath?

Have you had a fever (above 37.5C degrees) in the last 14 days?

Have you had any close contact with anyone who has tested positive for COVID-19 in the last 14 days?

I have understood, read and completed this form truthfully to my knowledge.

I knowingly and willingly consent to having services at this business during the COVID-19 pandemic.

I confirm to my knowledge that I, my household or social bubble have not been in contact with anyone that has had symptoms of COVID-19 in the last 14 days or anyone who has been self-isolating.

I consent for the services to be carried out which involves a staff member of the team being in physical contact with me with less than 2 metres distance.

To prevent the spread of the virus and protect each other, I confirm that I will strictly follow the businesses guidelines.

I confirm that I release the staff member(s) performing the service and the business from any and all liability for the unintentional exposure or harm due to COVID-19.

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Section 1 of 2: Client details

Personal Information

Section 2 of 2: Custom section

Covid 19

Following the COVID-19 pandemic, we’ve put extra measures in place for the safety of you and our staff members. We require all clients to fill in our COVID-19 Form before arrival so that we can provide the best possible and safe experience to our clients and staff members.

Please carefully read and answer the below questions. This information will be stored confidentially and securely by us.

If you or a member of your household has developed a cough, fever, breathlessness, sore throat or headaches within the 14 days, please contact us before your appointment so we can obtain further information from you and advise.

Please get in touch if you have any questions - we’re looking forward to welcoming you back.

Do you, or anyone in your household, have any flu-like symptoms?

Are you experiencing a cough?

Are you experiencing a shortness of breath?

Have you had a fever (above 37.5C degrees) in the last 14 days?

Have you had any close contact with anyone who has tested positive for COVID-19 in the last 14 days?

Add a new question or item

Personal Information

Covid 19

Following the COVID-19 pandemic, we’ve put extra measures in place for the safety of you and our staff members. We require all clients to fill in our COVID-19 Form before arrival so that we can provide the best possible and safe experience to our clients and staff members.

Please carefully read and answer the below questions. This information will be stored confidentially and securely by us.

If you or a member of your household has developed a cough, fever, breathlessness, sore throat or headaches within the 14 days, please contact us before your appointment so we can obtain further information from you and advise.

Please get in touch if you have any questions - we’re looking forward to welcoming you back.

Do you, or anyone in your household, have any flu-like symptoms?

Are you experiencing a cough?

Are you experiencing a shortness of breath?

Have you had a fever (above 37.5C degrees) in the last 14 days?

Have you had any close contact with anyone who has tested positive for COVID-19 in the last 14 days?

Clients

COVID 19

Created on 20 Mar 2023

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