Create A Cut Hair & Beauty COVID-19 questionnaire & consent form

As per the Government Guidelines the most important symptoms of coronavirus (COVID-19) are recent onset of any of the following

a new continuous cough
a high temperature
difficulty breathing
a loss of or change in your normal sense of taste &/or smell (anosmia)

It is imperative that you answer this questionnaire accurately and agree to do so. Inaccurate answers put yourself, other salon users and salon staff at increased risk of exposure to the COVID-19 virus.

Have you or has anyone you live with experienced any of the above symptoms in the last 14 days?*

YesNo

Are you currently experiencing any of the above symptoms?*

YesNo

Have you tested positive or been in contact with anyone who has tested positive for COVID-19 in the past 14 days?*

YesNo

Are you awaiting the results of a COVID-19 test ?*

YesNo

Have you travel abroad in the last 14 days?*

YesNo

I understand that Create A Cut Hair & Beauty is required by the government to collect & retain clients information, for a limited time period, for the purposes of the COVID-19 contact tracing scheme. I understand that my information will be provided by the salon to the COVID-19 contact tracing scheme if required to do so.*

Yes. By checking this box I understand & accept this statement

If you have answered yes to any of the above questions or you are unsure, you must cancel your appointment immediately & seek medical advice. You will not be charged a cancellation fee & we will reschedule your appointment for a later date once the period of self isolation is over, as per government guidelines.

Client details

Name*

First NameLast Name

Date*

Date

Phone Number*

Area CodePhone Number

Email

example@example.com

I confirm I have been truthful and accurate with my answers*

Yes

To prevent the spread of COVID-19 & help protect myself, other salon users and salon staff, I understand I will have to follow the salons strict guidelines at all times while I at Create A Cut Hair & Beauty*

Yes. By checking this box I understand & accept this statement

I understand that COVID-19 is a highly contagious virus & understand that every possible precaution has been taken by the salon. I further acknowledge that the salon can not guarantee that I will not become infected with COVID-19. I voluntarily seek the service provided by the salon. I accept any & all risk of being exposed to &/or contracting COVID-19. I knowingly & willingly consent to have Hair/Nail/Beauty/Massage carried out by the salon staff at my own risk & release Create A Cut Hair & Beauty of any liability should I contract COVID-19.*

Yes. By checking this box I understand & accept this statement

Signature

This information will be held confidentiality and in compliance with GDPR along with your normal client consultation forms and in line with government and insurance requirements.

COVID 19 Health Questionaire & Consent Form