2022 Priya Screening form
All clients must fill out a new screening form before your appointment with us.
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Full Name *
Phone Number *
Email address *
I hereby certify that *
Required
I am not waiting for COVID test results *
Required
I hereby certify that *
Required
I hereby certify that *
Required
I will let Priya know if my health status has changed before my appointment if i have filled this form more than 24hrs in advance of my appointment. *
Required
I will come to Priya wearing a mask and keep it on for the duration of my visit? *
Required
I have read the information on www.priyatherapy.com about the terms and conditions of making an appointment and i am aware of the cancellation policy of 24/48 hours? Full T&C's on our website www.priyatherapy.com  *
Required
TINTING & LASH LIFT INFO: I am aware that ALL tinting and lash lifting clients require a 48hr PATCH TEST.  PREGNANT or BRESTFEEDING women need a patch test for EVERY VISIT. We also can not do any tint or lift on clients that are under 16. You need to re patch test after every vaccine/booster (2 weeks after) *
NOTE: When in Priya, please adhere to our in-salon standard processes/procedures regarding infection control, i.e. hand washing/hand sanitising and general coughing/sneezing etiquette?
Private Data Protection Notice: This data sheet will be stored confidentially and is not shared with any third party, unless there will be an official request by the local authorities for reasons of public interest in the area of public health.The datasheet will be deleted one month after collection, unless a longer period is required by the public authorities.Thank you for your cooperation!
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