Covid-19 Pre-Treatment Questions

Covid-19 Pre-Treatment Questions

We are committed to providing a safe environment for our clients and have adopted a strict COVID-19 Infection Prevention and Control policy. As part of this policy we require all clients to complete the following pre-screening COVID-19 questionnaire at least 3 days before your treatment.
Name

First Name Last Name
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Date

Month Day Year
Date
Have you had COVID-19?

Yes No
Have you tested positive for COVID-19 in the last 14 days or are you awaiting for a COVID-19 test result?

Yes No
Have you recently experienced in the last 14 days any of the following symptoms of coronavirus (COVID-19):

Yes - A new continuous cough Yes - A high temperature Yes - A loss or, or change in, normal sense of taste and smell (anosmia) None of the above
Has anyone you live with experienced any of the symptoms above, been tested positive for COVID-19 in the last 14 days, or is awaiting the results of a COVID-19 test?

Yes No
Are you classed as an extremely vulnerable person (high risk)? (You will have had a letter from the NHS)

Yes No
Are you classed as a vulnerable person (moderate risk)?

Yes No
If the answer is yes to any of the questions above, you must cancel your appointment and follow Government guidance on self-isolation.
NOTE: We have worked hard to put into place some new safety regulations to make your visit to our salon as safe as it can possibly can be. However, we must make you aware that there is a risk of exposure to COVID-19 which exists in any public place where other members of the public are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. By visiting our salon, you accept that you do so at your own risk and that the salon cannot be held responsible for the potential expose to and infection by COVID-19.
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