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Nail & Beauty Salon in Halesowen

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Covid-19 Health Declaration Form

How are you feeling today?

As your appointment is due to come, and to help spreed the Covid19 you need to fill up this for before you atend to your appointment.

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Phone

Thanks for submitting!

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