To ensure the Safety & Health of all our clients and visitors, please complete this questionnaire truthfully and honestly prior to entering/arrival to our salon.

Ireland is part of the EU "traffics lights" approach to travel, which applies to countries in the EU/EEA. From 4th February 2021, a legal requirement to home or hotel quarantining has been introduced for all passengers arriving in Ireland. If you have been abroad in the last 14 days, please do not arrive at the salon and follow public health advice.

1. Have you returned from travel abroad/outside of Ireland in the last 14 days?

2. Have you been diagnosed with confirmed or suspected Covid-19 infection

in the last 14 days?

3. Are you awaiting the results of a Covid-19 test?

4. Do you have symptoms of cough, fever high temperature, difficulty breathing, loss or change in your sense of smell or taste now or in the past 14 days?

5. In the past 14 days have you been in contact with a person who is a confirmed or suspected case of COVID-19?

6. Have you been advised to self-isolate at this time?

7. How are you feeling Healthwise?

I declare that information I have given is correct and I have not knowingly withheld any information concerning my health. I am in agreement to proceed with the treatment discussed and accept that my participation in the treatments is by my own choice. I agree to have my data held by NuMi by IZAN for the purpose of proceeding with my treatments and understand that it will be held in accordance with the General Data Protection Regulations. Acceptance and signature on this questionnaire constitutes acceptance of NuMi Covid Client's Guideline, Privacy Policy and NuMi Terms and Conditions, which are subject to change. I agree to receive marketing information from NuMi by IZAN re appointment reminders, e-newsletters, special offers, birthday vouchers, seasonal greetings.