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Pre Appointment Health Questionnaire
*
Indicates required field
Name
*
First
Last
Name of the person wishing to visit oasis & claim the discount
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:
*
No Covid Related Symptoms
Fever
Cough
Respiratory Disorders
Loss of Smell or Taste
Other covid symptoms
Please tick if any of these conditions listed below are applicable to you?
*
No medical conditions
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
Have had a positive aids or hepatitis test
Please type below if your taking any medication or there are any other health conditions we should be made aware of.
*
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.
*
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
Please type below if you have knowingly been allergic to any treatment or ingredients
*
If not applicable please type NON, if yes please type the details here.
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