Covid-19 Health Declaration Form

To prevent the spread of Covid-19 and to reduce the risk of exposure and infection to others, we are conducting a simple screening questionnaire and health declaration form with our customers. This is important to us so that we can take all precautionary measures necessary to protect you and everyone else involved by providing our services. You do not have to provide us with the information sought in this form. However, if this information is not provided, Flame Beauty will not be able to proceed with your appointment. Thank you for your cooperation.

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

I understand that due to the frequency of visits to other clients, the characteristics of the virus, and the characteristics of beauty services, that I have an elevated risk of contracting the virus simply by having a treatment.

Have you or any member of your household any reason to suspect they may have been in contact with someone suffering from Covid-19 symptoms within the last 14 days?

Do you have any current symptoms of illness? Symptoms include but are not limited to a high temperature, shortness of breath, dry cough, sore throat, loss of sense of taste or smell, cold/flu like symptoms.

Are you self isolating because you or a member of your household has been diagnosed with/displaying symptoms of Covid-19, or been in contact with a positive case in the past 14 days?

At the time of completion and to the best of my knowledge, I am not aware of anyone suffering symptoms of Covid-19 and if this should change thereafter I will notify Flame Beauty immediately.

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