COVID – 19 CLIENT TREATMENT CONSENT FORM

ALL CLIENTS MUST HAVE UNDERSTOOD, READ & SIGNED THIS CONSENT FORM PRIOR TO HAVING THEIR TREATMENT AT ANY OF THE CLINICS ABAESTHETICS LTD.  FAILURE TO DO SO WILL RESULT IN YOUR TREATMENT BEING CANCELLED.

I understand that the Corona-virus causes the disease known as COVID-19.

 I understand the Corona-virus has a long incubation period during which the carriers of the virus may not show not show the symptoms and may still be contagious.

I understand that physical distancing of 2 metres may not be possible while in the clinic receiving services.

I understand that I must sanitise my hands before entering the salon.

 I must wear a mask that covers my mouth and nose while in common areas.

 I will minimise touching hard surfaces such as door handles, Ipads, payment terminals, and counter-tops and will be wiped after each client.

I confirm that I am not currently positive for novel corona virus and do not have the symptoms mentioned above.

I confirm that I am not waiting for the results of a laboratory test for the novel corona virus.

I verify that I have not returned to any country outside of the UK, whether by car, air, bus or train in the past 14 days.

I verify that I have not been identified as a contact of someone who has test positive for the novel corona virus or been asked to self-isolate by The Department of Health, or any other government agency.

I confirm that I am not presenting with any of the following symptoms of COVID-19 identified by the DOH

            Fever > 38C, or 100F

           Chills or Body aches

            Cough

            Sore Throat

            Shortness of breath

            Difficulty breathing

            Flu-like symptoms

            Runny Nose

            Loss of smell or taste

 

I confirm that I am not in high risk category for increased illness or death from COVID-19, including : diabetes, cardiovascular disease, hypertension, lung disease including moderate to severe asthma, being immunocompromised (including transplant recipient), having active malignancy or over the age of 70.

I understand that for the safety of everyone, my temperature will be check before any treatment is commenced. 

I understand that I may be unable to proceed with services at ABaesthetics LTD  if they are deemed unsafe to myself or a staff member

I understand I may NOT bring children or anyone else who does not have an appointment into the clinic.

I understand the staff of ABaesthetics LTD will do everything possible to minimise the spread of COVID – 19, but will not hold them responsible should I contract the COVID – 19.

I will immediately notify the Clinic if I contract the virus within two weeks following my visit.

Temperature ………………………………………………….

 Area temperature taken …………………………………..

Recording ………………………………………………………

I verify that the information I have provided on this form is truthful and accurate.

Client Signature ………………………………………………………………… Date 

Aesthetic Practitioner  Annie Benton 

Thank YOU for your co operation