2021 Priya Screening form
All clients must fill out a new screening form before your appointment with us.
Full Name *
Phone Number *
Email address *
I hereby certify that *
Required
How are you feeling Health wise? *
I hereby certify that *
Required
I hereby certify that *
Required
I will let Priya know if my health status has changed before my appointment if i have filled this form more than 48hrs in advance of my appointment. *
Required
I will come to Priya wearing a mask and keep it on for the duration of my visit? *
I have read the information on www.priyatherapy.com about the terms and conditions of making an appointment and i am aware of the cancellation policy of 24/48 hours? Full T&C's on our website www.priyatherapy.com *
TINTING & LASH LIFT INFO: I am aware that ALL tinting and lash lifting clients require a NEW PATCH TEST (even if you have had tinting or lash lift done here before) This needs to be done 48hrs before my treatment. Please let us know if your are PREGNANT as we can not do the above services at the moment. (We are looking into a recommended brand for our pregnant clients) We also can not do the above on clients that are under 16. PLEASE NOTE: a patch test or a service requiring a patch test CAN NOT be done if you have received your vaccine over the last 2 weeks before your appointment/patch test appointment. *
NOTE: When in Priya, please adhere to our in-salon standard processes/procedures regarding infection control, i.e. hand washing/hand sanitising and general coughing/sneezing etiquette?
Private Data Protection Notice: This data sheet will be stored confidentially and is not shared with any third party, unless there will be an official request by the local authorities for reasons of public interest in the area of public health.The datasheet will be deleted one month after collection, unless a longer period is required by the public authorities.Thank you for your cooperation!
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