Consultation Form

  • Consultation Form

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  • Medical Information - please tick all that apply

  • 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.

  • Date
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  • 1) Are you experiencing a cough?*
  • 2) Are you experiencing shortness of breath?*
  • 3) Have you had a fever (above 37.7C degrees) in the last 14 days?*
  • 4) Have you noticed a loss or change in your sense of smell or taste?*
  • 5) Have you or anyone in your household travelled in or out of the UK in the past 14 days?*
  • 6) Have you had any contact with anyone that has suspected COVID-19 in the last 14 days?*
  • 7) Have you visited a Tier 2 (High) or Tier 3 (very high) area in the past 14 days?*
  • Agreement*
  • Should be Empty: