Client health survey
Please fill in this form if you are having hair colour/ cut at my studio
Please answer the following questions to be able to continue your appointment/ booking.
Email *
Name *
Please provide your residential address. This is a Health Department requirement. *
Mobile number *
To my wonderful clients and brides
I have had so many changes to my business due to the COVID-19.
I am looking to keep my family, myself and my clients safe and reduce the impact on my household.

I am limiting the number of clients on my colour/ cut client list as well as having one person in the salon at one time. I will have limited to no cross over with other clients to allow more time to clean and disinfect furniture and equipment.

Please be aware there may be a need to postpone appointments if myself or family members are unwell or there are more reported cases in Toowoomba and therefor higher risk for infection or the government directs salons to close. For weddings I do have a team of stylists that I can call on to assist if one of our stylists are unwell.

I am asking people to submit a questionnaire prior to your visit so to ensure all our safety.

If you wish to postpone your appointment I will not be offended. If you wish to wear a mask I will not be offended.

Please be aware I may refuse service in the politest way possible if anyone is unwell or not adhering to government requirements. If you are concerned please call me to discuss.

Thank you so much for your understanding.
Please read the information from the link below and tick yes to acknowledge you have read and understand the importance. *
Please read the information from the link below and tick yes to acknowledge you have read and understand the importance. *
I acknowledge that I may be required to wear a mask and will provide a medical exemption if I can not. *
Have you travelled or been outside of Queensland in the last 14 days? If so, please provide location, length of stay, return to Queensland date and if you have quarantined. *
Have you experienced a cough, fever, tiredness, difficulty breathing (severe cases)?
Clear selection
Do you feel unwell OR have your been unwell OR any of your family or household members feel or been unwell? This includes snuffly noses and head colds or any contagious condition that may impact my ability to work. Service may be refused at your expense if not notified. *
Have you downloaded the COVID safe app? *
Please be aware we will not be performing services for people that have travelled to or live in COVID hot spots. I am happy to discuss each individual case if you have questions as situations change quickly.
Clear selection
I am ill I am to notify you via phone, text or email to cancel/ postpone my appointment. *
Have you been in contact with anyone who has been unwell or been tested for COVID-19? *
Have you been tested for COVID 19 in the last two weeks? Please provide your negative test result to attend you appointment. *
Any further questions or information?
Please select one of the following; *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy