COVID-19 Client Form

Please contact us by telephone at 01923 238 879 if you have any queries regarding this form

Please read and complete this form as accurately as possible before your appointment

This will reduce unnecessary contact during your appointment and help reduce the spread of coronavirus

Please familiarise yourself with the salon guidelines which will be sent to your email address together with a copy of your answers

First Name (required)

Last Name (required)

Your Telephone Number (required)

Your Email (required)

1) Have you or anyone in your household had COVID-19 in the last month?
YesNo

2) Have you or anyone in your household had any of the following symptoms in the last 14 days:
Fever, high temperature, continuous cough, loss of sense of taste or smell?
YesNo

3) Have you been in close contact with anyone with confirmed COVID-19 without wearing appropriate PPE?
YesNo

4) Have you travelled outside the UK in the past 14 days?
YesNo

Please contact us if you answered Yes to question 4.

5) Are you in a high risk category (clinically extremely vulnerable) as defined by the UK government?
YesNo

6) Are you in a moderate risk category (clinically vulnerable) as defined by the UK government?
YesNo

Any further comments