Thank you for booking

In advance of your appointment with us, please complete the screening checklist below. The information you provide will help us to keep you and others safe.

Name *

Date of Birth *

1. Have you experienced ANY of the following symptoms within the last 14 days? *

Temperature or feeling feverish
New cough
Sore throat
Shortness of breath
Flu-like symptoms (fatigue, headache)
Nausea or diarrhoea
Chills or shivering
Muscle pains or rash
Loss of taste OR smell
Non of the above

2. Have you or any of your family members or close contacts been diagnosed or suspected of having COVID-19 *

If Yes, please provide details (Type of test carried out, result of test & the date you had the test):

3a. Are any of your family members or close contacts experiencing Fever, Cough, Shortness of breath or Flu-like Symptoms? *

3b. Are any of your family members or close contacts experiencing Sore throat, Muscle aches, Fatigue, Nausea & Diarrhoea? *

If Yes, please provide details:

4. Have either you, a family member or a close contact recently travelled internationally, within the UK or attended an event in the last 15 days? *

If Yes, please provide details (where and when):

LOOK GOOD FEEL CONFIDENT

Skin and facial rejuvenation provided in a safe clinical environment by a highly qualified professional independent nurse prescriber.

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