Consultation Form

Please make sure this form is submitted as soon as possible before your treatment. Without this form being completed, your treatment will not be able to go ahead and will be cancelled.

Name

First NameLast Name

Date of Birth

Date

Phone Number

Area CodePhone Number

Email Address

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Allergies - Please include all

Medication - Please include all

How did you hear about Nails by Louise G?

Do you have any of the following symptoms? - Cough, shortness of breath, high fever, muscle pain, body ache, nausea or loss of taste/smell?

Within the last 14 days, have you been in contact with anyone that has any of the symptoms above?

Are you living with anyone that is quarantined OR unwell due to COVID-19?

By checking all the boxes, you confirm that you agree with the following statements:

By signing below, I confirm that I understand and agree to all terms and statements in this form.

I agree not to visit the salon for any services provided if I have any symptoms of COVID-19. I acknowledge that the information that I have given in this consent form is accurate and conplete.

Customer's Signature

Date Signed

Date

Consultation Form

COVID-19 Consent Form