Aesthetics COVID-19 Client Form

First Name

Last Name

Phone

Birthday

Address

Occupation

How often do you exercise?

Please list any skin or health conditions you are experiencing

Covid-19 Screening

Appointment Guidance

If you have answered yes to any of the above questions we will be in contact as you may need to reschedule your appointment with us.
Please only attend at your appointment time.
Please ensure you are on time - if you are late this may result in your appointment being cancelled.
Please attend your appointment unaccompanied.
Please limit the personal possessions you bring with you.
Please wear a face mask/covering to your appointment.
Upon arrival please wait until you are called forward to reception.
Upon arrival please use the hand sanitiser provided.
Please maintain social distancing where possible.
If you experience Covid-19 symptoms after your appointment please contact us immediately.

Please tick each statement to show your understanding and agreement.

I’m willing to get my body temperature checked before beginning my salon/clinic services. If my temperature is above 37 degrees celsius I agree to not visit the salon/clinic for the next 14 days

I agree not to visit the salon/clinic for any of the services provided if I have the symptoms of Covid-19. I acknowledge that the information I have given in this consent form is accurate and complete.

Your Signature

Thanks for submitting!