Georgina Leavold | Bringing Bodies Back into Balance

Covid-19 Consent Form

COVID 19 Pandemic

Body Treatment Consent Form

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Full Name

Contact Number:

Your Address:

I knowingly and willingly consent to having body related treatment during the COVID-19 pandemic.

Agree

I understand the Covid-19 virus has a long incubation period during which carriers of the virus may not show any symptoms and still be highly contagious. It is impossible to determine who has it and who does not, given the current limits in virus testing.

Agree

I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of the clinic services, that I have an elevated risk of contracting the virus simply by being in the salon.

Agree

I confirm that I am not presenting any of the following symtoms of Covid-19 : A temperature above 37.8C or higher, shortness of breath, loss of sense of taste or smell, dry persistant cough or sore throat.

Agree

I confirm that I have not been around anyone with these symptoms in the past 14 days and do not live with anyone who is sick or quarantined.

Agree

To prevent the spread of contagious viruses and to help protect each other, I understand that I will have to follow the clinic's strict guidlines.

Agree

I verify that I have not travelled outside the UK in the past 14 days to countries that have been affected by Covid-19.

Agree

I wish to proceed with my treatment and will not hold the clinic in anyway responsible if I was to go on to show any symptoms of the virus.

Agree

Please type your full name below. By typing and submitting, this serves as a Digital Signature and verifies that you fully agree to our safety policy for our services. This digital signature holds the same authority as a handwritten one.

Date of signature

Georgina Leavold

Bringing Bodies Back into Balance

Isle of Wight, Hampshire

georgina@georginaleavold.co.uk

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Contact Us

Georgina LeavoldBringing Bodies Back into Balance Isle of Wight, Hampshire

georgina@georginaleavold.co.uk

Georgina Leavold

Bringing Bodies Back into Balance

Isle of Wight, Hampshire