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Covid-19 Client Consultation

ALL CLIENTS MUST HAVE UNDERSTOOD, READ & SIGNED THIS CONSENT FORM PRIOR TO HAVING THEIR TREATMENT AT LA ROSS AESTHETICS- FAILURE TO DO SO WILL RESULT IN YOUR TREATMENT BEING CANCELLED.

You must tick next to each statement -

I understand that the Corona-virus causes the disease known as COVID-19.

I understand the Corona-virus has a long incubation period during which the carriers of the virus may not show the symptoms and may still be contagious.

I understand that physical distancing of 2 metres may not be possible while in the clinic receiving services.

I understand that I must sanitise my hands before entering the salon.

I must wear a mask that covers my mouth and nose while in common areas.

I will minimise touching hard surfaces such as door handles, Ipads, payment terminals, and counter-tops and will be wiped after each client.

I understand the bathroom facilities will be closed within the clinic due to guidelines.

I understand that refreshments will no longer be available in the clinic so if I want to have a drink of water this must be fine prior to entry.

I confirm that I am not currently positive for novel coronavirus and do not have the symptoms mentioned above.

You cannot have any of the mentioned treatments within the Vaccination timeframe: 2 weeks prior and 3 weeks after you have had your vaccination- treatments are; Dermal fillers, Profound, Fat Dissolving, Microblading, Botulinum Toxin A.

Should you ignore this disclaimer and hide this from the clinic, la ross Aesthetics cannot be held liable for any issues caused or reactions- If you have been vaccinated and attend the clinic for treatment and develop any adverse reactions then you need to seek medical advice at your first opportunity: Please note that the proceeding treatment may alter your immunity to covid-19.

I verify that I have not been identified as a contact of someone who has tested positive for the novel coronavirus or been asked to self-isolate by The Department of Health, or any other government agency.

I confirm that I am not presenting with any of the following symptoms of COVID-19 identified by the DOH: Fever > 38C, or 100F, Chills or Body aches, Cough, Sore Throat, Shortness of breat, Difficulty breathing, Flu-like symptoms, Runny Nose, Loss of smell or taste

I confirm that I am not in the 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 70.

I understand that for the safety of everyone, my temperature will be check before any treatment is commenced and if I refuse, I lose my appointment.

I understand that I may be unable to proceed with services at La Ross Aesthetics if they are deemed unsafe to myself or a staff member.

I understand I may NOT bring children or anyone else who does not have an appointment into the clinic.

I understand where possible I need to leave belongings away from the clinic and phones may not be taken out in the clinic.

I confirm that further lockdown measures or self-isolation measures taken by client or practitioner may impact any follow-up appts or review appts.

I understand the staff will do everything possible to minimise the spread of COVID – 19, but will not hold them responsible should I contract the COVID – 19.

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

I verify that the information I have provided on this form is truthful and accurate.

Submission confirmation:

I understand and acknowledge that by ticking this box, I am legally agreeing to all of the statements in this form.

Thanks for submitting!

info@larossaesthetics.com

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