COVID-19 Form

Name *

Email *

In the last 14 days have you been in close contact (within 2 meters) with someone who has confirmed COVID-19? *

YESNO

Have you experienced any of the following symptoms in the last 14 days? *

FeverDry CoughSore ThroatShortness of breathLoss of taste and/or smellNONE OF THE ABOVE

Are you currently living with someone who has experienced any of the above symptoms within the last 14 days? *

YESNO

Have you travelled overseas within the last 14 days? *

YESNO

I agree to immediately notify Angel Beauty if i contract the virus within 14 days following my visit? *

I understand that i may be unable to proceed with my appointment if its deemed unsafe for myself or my therapist *

Client Signature *

Date *