SALON PRE-APPOINTMENT HEALTH CHECK

SALON PRE-APPOINTMENT HEALTH CHECK
Thank you for taking the time to fill out this pre-appointment health check before your appointment. Due to the recent outbreak of COVID-19 [INSERT BUSINESS NAME] is taking extra precautions to ensure the care of every client.
Please note, if you are unable to fill out this form online, we'll need you to come to the salon 10 minutes before your appointment time to fill it out in the salon before we can proceed with treatment.
Name
First NameLast Name
Email
example@example.com
Phone Number
Area CodePhone Number
PRE-APPOINTMENT COVID-19 QUESTIONS
I have been in contact with a person with a confirmed cased of COVID-19 in the past 14 days*
YesNo
I have returned from overseas in the past 14 days*
YesNo
I am currently in government mandated self-isolation*
YesNo
I have had any of the following symptoms in the past 14 days: sore throat, a cough, a fever, difficulty breathing*
YesNo
If you have answered yes to any of the above questions, please understand we will not be able to proceed with treatment at this time.
There is no need to continue completing this form please give us a ring to let us know you will not be able to attend your appointment.
FURTHER COVID-19 QUESTIONS
I have been in close contact/ live with someone who has returned from overseas in the past 14 days*
YesNo
I have been in close contact or living with someone who is currently self-isolating?*
YesNo
I am caring for someone who is unwell with a sore throat, a cough, fever or breathing difficulties*
YesNo
I have been in close contact/ live with someone in the last 14 days who cares for someone with a confirmed or suspected COVID-19 case*
YesNo
I have been in close contact/ live with someone in the last 14 days who cares for someone with a confirmed or suspected COVID-19 case*
YesNo
APPOINTMENT POLICY
As well as our rigorous disinfection and sanitisation procedures in the salon we ask you, our clients to adhere to the following procedures to prevent the spread of COVID-19:
- Contactless and card payments where possible
- Come alone to your appointment
- Keep personal belongings to a minimum
- Sanitise your hands upon entering the salon and before leaving
- Wear the mask provided
BY COMPLETING THIS FORM AND SIGNING THIS ACCEPTANCE I AGREE THAT:
COVID-19 has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, [INSERT BUSINESS NAME] has put in place many preventative measures to reduce the spread of COVID-19.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and by attending an appointment at [INSERT BUSINESS NAME] I do so at my own risk.
- I do not currently have any symptoms of COVID-19
- I have not knowingly been in contact with confirmed case of COVID-19 in 14 days
- I have read and answered the questions above truthfully
- I have read, agree to and have signed this waiver
Signature
Clear
Date
MonthDayYear
Date
Should be Empty:

SALON PRE-APPOINTMENT HEALTH CHECK

PRE-APPOINTMENT COVID-19 QUESTIONS

FURTHER COVID-19 QUESTIONS

APPOINTMENT POLICY

BY COMPLETING THIS FORM AND SIGNING THIS ACCEPTANCE I AGREE THAT: