JUNIPER BEAUTY ROOM

COVID-19 HEALTH QUESTIONNAIRE

Please complete the following COVID-19 Health Questionnaire and click the SEND button at the foot of the page prior to your visit with us.

Name *

First

Last

Email *

Contact Number *

Address *

Have you or anyone in your household been diagnosed with COVID-19 in the last 14 days? *

Have you or anyone in your household suffered from dry cough/fever/ high temperature/shortness of breath/ loss or change in taste or smell in the last 14 days? (copy) *

Have you travelled outside the UK in the last 14 days? *

Are you in the High or Moderate Risk catagory (clinically vulnerable) as defined by UK Government? *

If you have answered Yes to any of the above questions, please give details. *

Any additional comments/information please give details.

We ask that all clients wear a mask whilst in the salon and that the hand sanitizer provided is used on arrival and can be used as you leave. Please bring as little with you as possible, attend alone and as close to your appointment time as possible. We will ensure that the salon is cleaned thoroughly between all appointments to make it the safest environment for clients and staff. Please inform us if any information changes between submitting this form and attending your appointment. We are required to keep your contact details for 21 days for Test & Protect purposes. If you have any concerns regarding this please discuss this with us at your appointment. *

I HAVE ANSWERED ALL QUESTIONS HONESTLY AND AGREE TO THE ABOVE CONDITIONS.