Covid 19 Disclaimer
Following the COVID-19 pandemic, we’ve put extra measures in place for the safety of you and our staff members. We require all clients to fill in our COVID-19 form before arrival so that we can provide the best possible and safe experience to our clients and staff members.

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

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 - we’re looking forward to welcoming you back.
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E-Mail-Adresse *
Personal Information
First Name *
Last Name *
Email Address *
Phone Number *
Questions
Please answer all of the below questions and choose one answer.
Are you experiencing a cough? *
Pflichtfrage
Are you experiencing a shortness of breath? *
Pflichtfrage
Have you had a fever (above 36.6C degrees) in the last 14 days? *
Pflichtfrage
Have you noticed a loss or change in your sense of taste or smell? *
Pflichtfrage
Have you had any contact with anyone that has suspected COVID-19 in the last 14 days? *
Pflichtfrage
Agreement
I have understood, read and completed this form truthfully to my knowledge. *
Pflichtfrage
I knowingly and willingly consent to having services at Skincare Cafe during the COVID-19 pandemic. *
Pflichtfrage
I consent for the services to be carried out which involves a staff member of the Skincare cafe team being in physical contact with me with lessthan 2 metres distance. *
Pflichtfrage
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. *
Pflichtfrage
To prevent the spread of the virus and protect each other, I confirm that I will strictly follow Skincare Cafe guidelines. *
Pflichtfrage
If guidelines are not strictly followed, I understand that Skincare Cafe has the right to cancel the appointment with the full cost of the service being charged and any other paid costs being non-refundable. *
Pflichtfrage
I confirm that I release the Skincare cafe staff member performing the service and Skincare Cafe as a business from any and all liability for the unintentional exposure or harm due to COVID-19. *
Pflichtfrage
Digitally Signed
Client Name *
Date *
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