Consultation Form

Are you taking any medication or supplements?

By submitting this form, you agree to the following: 1) I hereby authorise Hannah Chapman, fully trained and qualified beauty therapist to perform treatments upon myself at The Beauty Shed. 2) I am fully aware that even with patch testing there is only a limited amount of exposure, and that a full treatment may have a different outcome. 3) I have read and understood the form and answered correctly to the best of my knowledge 4) I understand the importance of informing my therapist of all medical conditions and medications I am taking, and to let the therapist know of any changes to these at any ongoing appointments. 5) I understand that it is my responsibility to inform my therapist of any discomfort I may feel during treatment so she may adjust the session accordingly. 6) I am aware that appointments are subject to late cancellation due to guidelines in place with COVID-19 regulations. 7) I have been given the chance to ask questions about the session and my questions have been answered. 8) I have read and understood the aftercare given to me and realise that i am responsible for the general care of my treatment once I leave The Beauty Shed.

Signature*

Client signature

Date

1) Are you experiencing a cough?*

NoYes

2) Are you experiencing shortness of breath?*

NoYes

3) Have you had a fever (above 37.7C degrees) in the last 14 days?*

NoYes

4) Have you noticed a loss or change in your sense of smell or taste?*

NoYes

5) Have you or anyone in your household travelled in or out of the UK in the past 14 days?*

NoYes

6) Have you had any contact with anyone that has suspected COVID-19 in the last 14 days?*

NoYes

7) Have you visited a Tier 2 (High) or Tier 3 (very high) area in the past 14 days?*

NoYes

Agreement*

I have understood read and completed this form truthfully to my knowledgeTo prevent the spread of the virus and protect each other, I confirm that I will strictly follow The Beauty Shed guidelinesIf guidelines are not strictly followed, I understand that The Beauty Shed has the right to cancel the appointment with the full cost of the treatment being charged and any other paid costs being non-refundableI confirm that I release Hannah Chapman the staff member performing the service and The Beauty Shed as a business from any and all liability for the unintentional exposure or harm due to COVID-19

Signature*

Client signature