COVID-19 (Wellness) Pre-Screening Questionnaire

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Coronavirus disease (COVID-19) has had an affect on us all and thankfully, the Government is allowing the Beauty Industry to reopen, albeit with updates to its Heath & Safety Guidelines. Whilst élégant nails is now allowed to offer treatments, it is important that those who are attending an appointment are well and present no symptoms.

The World Health Organisation (WHO) have listed the symptoms of COVID-19 and what you need to look out for:

Most common symptoms:
•fever
•dry cough
•tiredness.

Less common symptoms:
•aches and pains
•sore throat.
•diarrhoea
•conjunctivitis
•headache
•loss of taste or smell
•a rash on skin, or discolouration of fingers or toes.

Serious symptoms:
•difficulty breathing or shortness of breath
•chest pain or pressure
•loss of speech or movement.

It is important that if you, or anyone in your household have had any of these symptoms in the past 14 days, you DO NOT attend your appointment. My priority is to keep you and I as safe as possible.

Email *

Please answer the following pre screening questions: *

Yes

Do you or anyone in your household have a fever or experienced a fever within the past 14 days?

In the past 14 days, have you or anyone in your household experienced a recent onset of respiratory problems, such as a cough or difficulty breathing?

Have you noticed a loss of, or change in, your normal sense of taste or smell in the past 14 days?

In the past 14 days, have you or anyone in your household come into contact with a patient with a confirmed COVID-19 infection?

Have you or members of your household recently participated in any gathering, meetings or had close contact with unacquainted people in the past 14 days?

In the past 14 days, have you or anyone in your house hold travelled outside of the UK?

Yes

Do you or anyone in your household have a fever or experienced a fever within the past 14 days?

In the past 14 days, have you or anyone in your household experienced a recent onset of respiratory problems, such as a cough or difficulty breathing?

Have you noticed a loss of, or change in, your normal sense of taste or smell in the past 14 days?

In the past 14 days, have you or anyone in your household come into contact with a patient with a confirmed COVID-19 infection?

Have you or members of your household recently participated in any gathering, meetings or had close contact with unacquainted people in the past 14 days?

In the past 14 days, have you or anyone in your house hold travelled outside of the UK?

Have you or anyone in your household felt generally unwell within the past 14 days? *

Yes

Other:

Required

Have you read the élégant nails' Coronavirus (COVID-19) Infection Prevention and Control Policy available on the website and understand the changes that have been put in place? *

Yes

Required

Is there anything that you’d like to make élégant nails aware of before attending your appointment? *

I can confirm that I have completed this questionnaire to the best of my knowledge and understand that if there are any changes to my wellbeing, I will make my technician aware before attending my appointment.

Full Name *

Contact Number: *

Date of completion: *

YYYY

A copy of your responses will be emailed to the address you provided.

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