» Amanda Clay Beauty Health Questionnaire

Amanda Clay Beauty Health Questionnaire

To be completed before appointment

Appointment Date*
Date Format: DD slash MM slash YYYY
Name*
First Last
Phone*
Email*
Enter Email Confirm Email
Do you have any of these symptoms: cough, shortness of breath, high fever, loss of taste/smell?*
- Yes
- No
Within 14 days of this appointment, have you been in contact with anyone that has COVID-19 symptoms or has been infected?*
- Yes
- No
- I work for the NHS but I have worn the correct and properly fitted PPE whilst dealing with patients within the last 14 days (you must advise me if you work for the NHS and haven't been supplied the correct PPE - I apologise for any inconvenience caused but the health and well being of my clients is paramount)
Have you or anyone you are living with been asked to self isolate or awaiting test results due to COVID-19?*
- Yes
- No
Date*
Date Format: DD slash MM slash YYYY
Consent*
I agree to the Covid-19 Salon Services Consent Form
By submitting this form, you agree to have beauty services done with Amanda Clay Beauty and agree to wear a face covering when required unless medically necessary to avoid. You also agree to wash and sanitise your hands at the salon and prior to your treatment, avoid brining in mobile phones or other devices and to avoid bringing guests, children or animals to your appointment for the purpose of health and safety during these unprecedented times. For contact tracing purposes we are required to store your personal details in accordance with GDPR and you agree to this.

I agree NOT to visit the salon for any of the services provided if I have any symptoms of COVID-19 or/and have knowingly been in contact with anyone showing symptoms or awaiting test results. I acknowledge that the information I have given in this consent form is accurate and complete. BY SIGNING BELOW, I CONFIRM that I UNDERSTAND and AGREE to all terms and statements in this form.

Your consent and data will be automatically deleted after 30 days.
Signature

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