Oasis Health Questionnaire

Pre Appointment Health Questionnaire

* Indicates required field

Name *

First

Last

Mobile Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

I hereby warrant that the above information is correct. On the assumption that attention is given by the staff of Oasis Health & Beauty, whilst receiving or taking part in any activity related to the treatments, use of equipments or advice recommended. I confirm that neither Oasis Health & Beauty or its staff are responsible to me if any injury to health or well-being is incurred. All information is stored according to European GDPR regulations. *

I agree

Please answer the following questions *

By ticking here I confirm that I have not mixed with any one who has tested positive with COVID 19 in the last 14 days Have you been tested positive with COVID 19? YES NO

If you have tested positive for COVID 19 please give the date & details below: *

Have you had any of the following new symptoms in the last 7 days: *

Please tick if any of these conditions listed below are applicable to you? *

Please type below if your taking any medication or there are any other health conditions we should be made aware of. *

Remember a patch test is required for Lash & Brow Tint, Lash Perm, IPL-Laser, Microblading. Please book 48hrs in advance. *

Please type below if you have knowingly been allergic to any treatment or ingredients *

Submit

Pre Appointment Health Questionnaire

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