Coronovirus health declaration

All clients receiving a service from Nicola Whitfield MUA must fill out this form 12-24 hours prior to their service.

In the event that the form is not received by Nicola Whitfield MUA I may have to decline to provide services to the client & any other persons for that booking.

 

Please note, for the purpose of this Questionnaire, contact with a person includes any of the following:

 

  • - Living in the same household regardless of whether you are social distancing or not.

  • - Face to face contact for any length of time regardless of whether PPE was worn or not.

  • - Being within 2m of another person outside your household for any length of time regardless of whether PPE was worn or not.

Coronavirus Covid - 19 Health Declaration

Have you or any member of your household experienced any of the following symptoms, in the past 14 days.  Including but not limited to;

muscle pain, diarrhoea and vomiting

loss of sense of smell and/or taste, extreme exhaustion

a new or persistent or dry cough, a temperature or shortness of breath

 

If yes, please provide the dates on which the symptoms were experienced and who experienced them in an email to muaniky99@gmail.com

Please tick all boxes which apply below:

* The full Coronavirus Policy can be found here

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