Covid-19 Policy & Guidelines

You can view my guidelines here COVID Guidelines 2021

You can view my policy here COVID Prevention & Control Policy

If my guidelines/policy aren’t followed than I will have to cancel your appointment.

COVID-19 Client Consent Form 2021

This form is required to be filled in at least 24hrs prior to each of your appointment dates. Unfortunately if this form isn't filled in prior to your appointment, it will be cancelled.

Name
First Last
Today's Date
Date Format: DD slash MM slash YYYY
Appointment Date
Date Format: DD slash MM slash YYYY
If you've had COVID or the COVID vaccine in the last 14 days please be aware that Vicky's Beauty Treatments may contact you to discuss your appointment.
Have you had the COVID vaccine?
- Yes - first dose
- Yes - both doses
- No
If you've had your vaccine, which one did you receive?
- Pfizer
- AstraZeneca
- Moderna
What date did you receive your first dose?
Date Format: DD slash MM slash YYYY
What date did you receive your second dose?
Date Format: DD slash MM slash YYYY
Have you or anybody in your household been experiencing/experienced and of the following:
Please tick all that are applicable.
- Exposure to COVID
- High temperature (fever)
- Continuous cough
- A change to your sense of smell or taste
- Shortness of breath
- Any rashes/spots/redness or swelling to your skin & feet.
- Shielding
- No
If you have ticked any of the above Vicky's Beauty Treatments is unable to treat you at this time.
Have you travelled internationally or are you intending to?
- Yes - Green light country
- Yes - Amber light country
- Yes - Red light country
- No
Has anything changed medically since your last treatment?
If so please advice below. (This includes COVID, COVID vaccine & any side effects, allergies and irritations)
It is mandatory to wear a mask whilst having a treatment and is part of Vicky's Beauty Treatments COVID guidelines. Please tick the box if you agree to this. (Please note if you don't agree Vicky's Beauty Treatments is unable to treat you at this time and your appointment will get cancelled.)
I agree to wear the appropriate PPE during my treatment. (Whether this be a mask or visor.)
It is now in Vicky's Beauty Treatments insurance policy to check and record your temperature before proceeding with your appointment.
I agree for Vicky's Beauty Treatments to take my temperature at each appointment.
I agree to contact you if I or anybody in my household develop COVID symptoms within 7 days of my treatment. (If this is the case Vicky's Beauty Treatments is obliged to pass your details on to the NHS Track & Trace.)
I agree to contact you & I am happy for you to pass on my details if required.
COVID Consent Agreement
Signing this agreement, you (the client) take full responsibility for your current and future health. You will not hold Vicky's Beauty Treatments responsible.

You agree to follow the COVID guidelines that Vicky's Beauty Treatments has in place to keep both you as the client and me as the therapist safe.

You have given the correct information and agree to all of the above and happy to proceed with your treatment/s during the COVID pandemic.

You will be asked to sign a paper copy of this agreement at your appointment.
I agree to the above and agree to sign a paper copy.

Mobile Beauty & Holistic Therapist

Covid-19 Policy & Guidelines

COVID-19 Client Consent Form 2021

Contact Us

Mobile Beauty & Holistic Therapist

COVID-19 Client Consent Form 2021

Contact Us

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