Nails by Mets COVID-19 Screening Questionnaire

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.

Area Code

Phone Number

4

Are you currently self isolating?* This field is required.Self-isolation is when you do not leave your home because you have or might have coronavirus (COVID-19).

YESNO

5

Have you come into contact with anyone who has tested positive for COVID-19 within the last 10 days? * This field is required.

YESNO

6

Do you have a new, continuous cough?* This field is required.

YESNO

7

Do you have a high temperature?* This field is required.

YESNO

8

Have you noticed a loss of, or change in, normal sense of taste or smell?* This field is required.

YESNO

9

Have you received the COVID-19 vaccination/booster in the last 14 days?* This field is required.Clients who have received the COVID-19 may wish to wait 14 days before receiving a Nails by Mets treatment. This is to allow time for the immune response from the vaccine to develop and cease before adding a treatment which has (low) potential risk for allergy and to wait for any negative side effects (feeling unwell etc) to subside. If you wish to postpone your appointment, please contact info@nailsbymets.com and we will arrange to rebook you in as soon as possible once your 14 days are up! We will also update your consultation form/records accordingly as this is a change to your medical history.

YESNO

10

Signature* This field is required.Please sign to confirm.

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