Client Consultation | LG Nails London

Covid-19 Health Declaration & Treatment Consultation

Face masks must be worn at all times throughout your treatment.

Full Name

Email

Myself or anyone in my household have not been advised to shield by the government

I am not experiencing any of these symptoms: fever, cough, sore throat, loss of taste or sense of smell (or any other flu like symptom)

I have not been in close contact with anyone who has tested positive for Covid-19 within the last 14 days

Please select any that may apply:

Pregnant

Severe headaches

Any skin rash or condition

Arthiritis

Diabetes

Varicose Veins

Surgeries (within past 12 months)

High blood pressure

Fibromyalgia/ Chronic fatigue

Any contagious disease/ Illness

Allergies to Acrylics, Plastics, Other

Inflammation/ Swelling

Injuries (within past 12 months)

Other medical condition

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

Initials

Date

Thanks for submitting!