Covid-19 Consultation Form

I understand that the novel coronavirus causes the disease known as COVID-19. I understand the novel coronavirus has a long incubation period during which the carriers of the virus may not show not show the symptoms and may still be contagious.

I understand that:

1. Physical distancing of 1.5 metres may not be possible while in the salon receiving services.
2. I must sanitise my hands before, or immediately after, entering the salon.
3. I must wear a face mask/covering at all times during my appointment.
4. I will minimise the touching of common surface/areas
5. I may be unable to proceed with services at Ultra Beauty Boutique if they are deemed unsafe to myself or a staff member
6. I may NOT bring children or anyone else who does not have an appointment into the salon.
7. I understand the staff of Ultra Beauty Boutique will do everything possible to minimise the spread of COVID-19, but will not hold them responsible should I contract COVID-19.

I confirm that:

1. I am not currently positive for COVID-19
2. I am not waiting for the results of a laboratory test for COVID-19
3. I have not returned to Scotland from any other State or Country, whether by car, air, sea, bus or train in the past 14 days
4. I have not been identified as a contact of someone who has test positive for COVID-19 or been asked to self-isolate by any government agency.
5. I am not in high risk category for increased illness or death from COVID-19, including : diabetes, cardiovascular disease, hypertension, lung disease including moderate to severe asthma, being immunocompromised (including transplant recipient), having active malignancy or over the age of 65.
6. I am NOT presenting with any of the following symptoms of COVID-19:
   1. Fever > 38C, chills or body aches
   2. Cough
   3. Sore Throat
   4. Shortness of breath / Difficulty breathing
   5. Flu-like symptoms
   6. Runny Nose
   7. Loss of smell or taste

I will immediately notify the salon if I contract the virus within two weeks following my visit.