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COVID-19 Pre-Screening Questionnaire

Please complete 48 hours** prior to your scheduled appointment. If you answer "yes" to any of the first four questions, please contact us immediately on 07484 118255 

In signing this form, you confirm that you understand and agree with the information contained therein, and that you consent to attending Taania Wood Micropigmentation to have treatment.

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**PLEASE NOTE - You must submit a completed form no more and no less than 48 hours prior to your scheduled appointment, ensuring also that you contact us immediately should you answer "yes" to any of the first four questions.

Failure to do so may result in your appointment being cancelled and your booking fee being forfeited. You will be required to pay a new booking fee before a new appointment is confirmed. 

It is important that we have the most current status of your health in relation to COVID-19 as possible, and that any changes to your booking can be made without triggering our cancellation policy.

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FIELDS MARKED * ARE MANDATORY

Within the last 14 days, have you had a temperature at or above 37.8c or had a sense of fever, or experienced a new cough, new shortness of breath, new sore throat, or loss of taste or smell that you cannot attribute to another health condition?*
Within the last 14 days have you or a member of your household had a positive Lateral Flow or PCR test?
Within the last 14 days have you or a member of your household been isolating?
Within the last 14 days have you travelled outside the U.K?
Have you received the COVID-19 vaccination?

IMPORTANT: If the date of your last vaccination was within the last 14 days, or if you are due to have a vaccination within the next 14 days, please contact us immediately at taaniapca@gmail.com

Thanks for submitting!

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