Sapphire Hair Peterborough
COVID-19 - Screening Questionnaire
You MUST complete this form before EVERY appointment.
Please enter your Full name. (First Name & Surname) *
What date was this form completed? *
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Date of your hair appointment *
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Have you or anyone in your household had Covid-19 in the last 14 days? *
Have you tested positive for Covid-19 in the last 14 days? *
Are you awaiting results from a Covid-19 test? If yes,please CANCEL your appointment until you know the result. *
Have you had any of the following symptoms in the last 14 days? *
Required
I understand that if I become ill with any symptoms, that I will cancel/rearrange my appointment. *
If you or a family member becomes ill/have any symptoms after your appointment, I will get in touch with Sapphire Hair Peterborough to inform them. *
I understand to keep you safe and to adhere to the government guidelines for 'Track and Trace' that this information will need to be kept for 1 month after your appointment. *
I confirm and agree that the information provided is correct and accept it is my responsibility to inform Sapphire Hair Peterborough if there are any changes in circumstances. *
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