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Pre Appointment Health Questionnaire
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Indicates required field
Name
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First
Last
Name of the person wishing to visit oasis & claim the discount
Mobile Number
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Email
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Adress Details
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Line 1
Line 2
City
State
Zip Code
Country
COVID RELATED QUESTIONS
In the last 14 days have you: Mixed with anyone diagnosed with COVID? Been Abroad? Had a Positive covid test?
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Yes
No
If you selected YES to any of the above Questions please give the details Here
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Please give further details, including dates of tests etc.
Have you had any of the following new symptoms in the last 7 days:
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No Covid Related Symptoms
Fever
Cough
Respiratory Disorders
Loss of Smell or Taste
I have had other covid symptoms
Have you had a covid vacine? Please type No or Yes and the date of the vacine below
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HEALTH RELATED QUESTIONS
If one or more of the conditions listed below is applicable, please select the main one and give further details below. Thank you
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High blood pressure
Low blood pressure
Epilepsy
Medical Back problems
Asthma
Heart disease
Arthritis/Rheumatisum
Gynecological problems
Varicose viens
Diabetes
Migraine
Allergies
Stress related conditions
Undergoing treatment for cancer
Pregnant
A positive aids/hepatitis test
Curently taking medication
No medical conditions
These questions allow us to know that the treatments select are suitable and safe for you.
If you have select anything from the list above or have knowingly been allergic to any treatment or ingredients please type the details here. If nothing applies type N/A
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If not applicable please type NON, if yes please type the details here.
Please type below if you're taking any medication or there are any other health conditions we should be made aware of.
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This helps us ensure the treatments chosen are not contraindicated.
Remember a patch test is required for Lash & Brow Tint, Lash Perm, IPL-Laser, Microblading. Please book 48hrs in advance.
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I don't require a patch test
Lash Tint Test Required
Brow Tint Test Required
Lash Perm Test Required
Microblading Test Required
Laser/IPL Test Required
I've had a patch test at Oasis in the last 6 month
If you request a patch test, please rember to book in 24 hrs prior to your appointment
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. I'm happy to recieve emails/messages from Oasis. All information is stored according to European GDPR regulations and not share out of the group.
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I AGREE TO THE ABOVE STATMENT
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