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
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