Top Floor, The River Club,
Old Malden Lane, Worcester Park, KT4 7PX

AS OF 16:00 on 18/05/2022, YOU NO LONGER NEED TO COMPLETE THE COVID SCREENING QUESTIONNAIRE

Covid-19 Screening Questionnaire

In order to protect our clients and staff we ask that you complete this Covid-19 Screening Questionnaire within the 48 hours before your appointment.

Contact phone number

A. In the past 5 days have you:

Had a high temperature (this means you feel hot to touch on your chest or back)
Had a new, continuous cough (this means you have been coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours - or if you usually have a cough, it has been worse than usual)?
Had a loss or change to your sense of smell or taste (this means you’ve noticed you cannot smell or taste anything, or things smell or taste different to normal)
Had more headaches than normal?
Been in contact with anyone who was showing any of the above symptoms?
Been tested positive for Covid-19?
To the best of your knowledge, been in contact with anyone who has tested positive for Covid-19?

Yes No

B. Are you waiting for the results of a Covid-19 test taken because you have had symptoms or felt unwell or been in contact with someone who has Covid-19?

Yes No

C. I confirm that I will comply with the Covid-19 precautions in place at the salon which include, but are not limited to, wearing a face covering and any PPE as requested by my therapist, washing my hands for at least 20 seconds after entering the salon and before my treatment commences, using the hand sanitiser provided before making payment.

Confirm Deny

D. I confirm that, if within the 5 days following my visit to Beauty Be Mine I test positive for Covid-19, I will immediately inform the salon.

Confirm Deny

E. I confirm that I understand a safety surcharge will be added to my treatment costs to partially cover the Covid-19 precautions which the salon has had to put in place.

Confirm Deny

F. I confirm that Beauty Be Mine may keep my answers to this questionnaire for up to 21 days after the date of my appointment.

Confirm Deny

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AS OF 16:00 on 18/05/2022, YOU NO LONGER NEED TO COMPLETE THE COVID SCREENING QUESTIONNAIRE

Covid-19 Screening Questionnaire