COVID 19 consultation form
COVID-19 Disclaimer

Following the COVID-19 pandemic, extra measures are in place for the safety of you and me.
All clients are required to fill in this COVID-19 form 24 hours before arrival. Failure to do so will result in your appointment being cancelled.

Please carefully read and answer the below questions.
This information will be stored confidentially and securely for 21 days for track and trace purposes.

If you or a member of your household has developed a cough, fever, breathlessness, sore throat or headaches in the last 14 days, please contact us before your appointment so we can obtain further information from you and advise.

Please get in touch if you have any questions - I'm looking forward to welcoming you back.
Personal Information
Forename *
Surname *
Phone Number *
Address *
Questions
Please answer all the questions.
1. Are you experiencing a new continuous cough? *
2. Are you experiencing any shortness of breath? *
3. Have you had a fever (above 37.7C degrees) in the last 14 days? *
4. Have you noticed a loss or change in your sense of taste or smell? *
5. Have you had any contact with anyone that has suspected COVID-19 in the last 14 days? *
6. Have you returned from a country that is NOT on the UK Coronavirus Travel Corridors list in the last 14 days? *
7. Please list any countries that you have visited in the last 14 days, outside of the UK.
Agreement
Please tick each statement to show your agreement.
No treatment will be carried out if you are unable to agree to ALL of the below statements.
I have understood, read and completed this form truthfully to my knowledge. *
Required
I knowingly and willingly consent to having services at Nail Creative during the COVID-19 pandemic. *
Required
I consent for the services to be carried out which involves a staff member being in physical contact with me with less than 2 metres distance. *
Required
I confirm to my knowledge that I, my household or social bubble have not been in contact with anyone that has had symptoms of COVID-19 in the last 14 days. *
Required
To prevent the spread of the virus and protect each other, I confirm that I will strictly follow Nail Creative's salon guidelines. *
Required
If guidelines are not strictly followed, I understand that Nail Creative has the right to cancel the appointment with the full cost of the service being charged. *
Required
I confirm that I release Pennie Rogers performing the service and Nail Creative as a business from any and all liability for the unintentional exposure or harm due to COVID-19. *
Required
Signature
Signature *
Today's date *
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