COVID-19 - How I'm working to keep us safe

Further to the release of the latest government guidelines for the beauty industry and as part of my new Health & Safety protocols, please complete this form prior to receiving any makeup services. Please ensure you and your bridal party complete this 24 hours BEFORE any service with me. I am committed to keeping you (and myself) safe whilst you are with me and by completing this form it enables me to do this. Thank you.

All fields must be completed.

Name (First and Last) *

Date

Telephone

Email

Full Address with Postcode *

Services required:

If choosing 'other' what service do you require? If not add None:

Lead Name of the Bridal Party eg: Brides surname

Role of those receiving makeup services

If choosing 'other' what role do you have? If not add None:

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

Are you awaiting those results? *
YesNo

Have you experienced the recent onset of any of the following symptoms of coronavirus (COVID-19):*

A dry continuous cough
Yes
High temperature
Yes
Loss or change of taste and sense of smell
Yes
Shortness of breath
Yes
A positive COVID-19 test
Yes
No, I am not experiencing any symptoms of COVID-19
No

Have you been in contact with anyone within the last 14 days who is now showing any of the above symptoms?*
YesNo

Contact with someone who has had Contact with a person who has or may have Coronavirus in the past 14 days.
YesNo

Whilst every effort will be taken to make the treatment environment as safe as possible, please be aware of the risks involved if you live with anyone who is classed as vulnerable.*
I am aware of the risks and wish to proceed with my appointment

For the purpose of 'Test and Trace' I give permission for my time of entry and departure to be recorded and I am happy for Fiona Miller to contact me if required.*
I Agree

Please be aware that I can only allow one client at a time (no guests/children). Please ensure you have read and agree to follow my arrival procedures as set out in my service protocol and procedures statement (they maybe subject to change, please check before each appointment).*

I have read and agree to follow the protocol and procedures: Coronavirus Policy - Download as a PDF
YesNo

I confirm that to the best of my knowledge, the answers I have given are correct and I have not withheld any information that may be relevant to my treatment. I certify that the preceding details are true and correct. I am aware that it is my responsibility to inform Fiona Miller of my current and ongoing medical or health conditions and to update this history where necessary. I am also aware this information is essential for Fiona Miller to execute appropriate treatment procedures. I understand that failure to disclose information requested above may result in harm to others to which I accept full liability/responsibility. I will follow all the guidance and requests that Fiona Miller asks of me and will be respectful of the environment for her and others using it.*
I agree and confirm

* All fields must be completed