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Beauty154 Consultation Card
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First Name
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Surname
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Address
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Date of Birth
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IMPORTANT - COVID-19 Questions
We are doing our best to operate in a safe environment for our staff and clients, if you tick any of the following, except 'None of the above' please ring the salon on 01524 847704 to re-arrange your appointment.
Please tick one or more of the following
*
I've travelled abroad to a non bridge country in the last 14 days, including Spain.
I've been unwell with a cough, temperature, loss of taste and smell withing the last 14 days.
I've been asked to shield due to being vulnerable.
I've been in contact with someone who has tested positive from coronvirus and have been contacted by test and trace.
None of the above.
Required
Consent
The treatment has been explained to me by the practitioner, and I have had the opportunity to ask any questions and these have been answered to my satisfaction.
I understand and agree to follow any post-treatment advice given
I have been informed in detail and understand possible risks, reactions, side effects must be reported to the practitioner as soon as possible.
I understand that no responsibility can be accepted by BEAUTY154 for any injury incurred to my self during the treatment where incorrect information has been given.
Consent
*
I have read the above consent and I confirm that by signing this form I consent to the treatment.
Required
I consent to my information being held by BEAUTY154 and I understand they will comply with GDPR. I consent to being contacted by;
*
TEXT
EMAIL
PHONE
Before and after photos been taken and used in advertising.
Required
A therapist will go through this form prior to any treatment being receive and explain the treatment and procedure in full.
Please initial. By entering your initials in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge
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