2021 New Customer Registration Form

I confirm that I have not had any of the following symptoms in the last 14 days: fever, shortness of breath, loss of sense of taste or smell, dry cough, runny nose or sore throat.

YesNo

I confirm that to the best of my knowledge, I have not been in close contact with anyone with confirmed COVID-19 in the last 14 days.

YesNo

To prevent the spread of contagious viruses and to help protect each other, and I understand that I will have to follow the salons strict guidelines

YesNo

I verify that I have not travelled outside of the United Kingdom in the past 14 days, to countries that have been affected by Covid - 19

YesNo

I agreed to all the above mentioned and wish to proceed with my treatment/s and do not hold the salon responsible if I was to show any symptoms of the virus.

YesNo

Have you had your Covid19 vaccination?

YesNo

If Yes please provide more information. Ie. Just the first vaccination

Signature*

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