01604 406 180

appointments@fongspa.com

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Client Health Questionnaire

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Client Health Questionnaire

Name*
First Last
Date of Birth*
Date Format: DD slash MM slash YYYY
Address*
Street Address Address Line 2 City / Town Post Code
Email*
Enter Email Confirm Email
Your Phone Number*
Emergency Contact Name*
First Last
Emergency Phone Number*
Health Questions

Common sense is your best guide when you answer this questionnaire. Please read the questions carefully and answer each one honestly: check YES or NO.
Have you been diagnosed with or been in contact with someone diagnosed/tested positive with COVID-19 in the past two weeks?*
- Yes
- No
Have you developed symptoms of COVID-19 or been in close contact with anyone exhibiting these symptoms in the past two weeks?*
- Yes
- No
Have you recently suffered from a new continuous cough, fever, chills, aches, shortness of breath or loss of taste or smell or generally felt unwell in the past two weeks?*
- Yes
- No
Do you suffer from any of the following health issues (please ensure to tick 'No Medical History' if none of the following apply)*
- Diabetes
- Epilepsy
- Rheumatism
- Asthma
- Allergies
- Pregnancy
- Heart condition
- No Medical History
- Other
Please provide details on any ticked boxes:
I have read, understood and completed this questionnaire. I have not withheld any known medical history or condition.
Initials*
Liability waiver

I agree to follow all COVID-19 hygiene recommendations by Fong Spa to keep others and myself safe. I hereby give my written consent for Fong Spa to carry out the treatments of my choice as requested by me.
Initials*
Cancellation policy

Cancellations hurt our business so please provide a minimum of 24 hours notice if you need to amend/cancel your treatment appointment.

I accept should the aforementioned required appointment cancellation notice not be provided, a 100% cancellation charge will apply to all appointments and refunds will not be issued.
Initials*
Date*
Date Format: DD slash MM slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

Welcome Back!

We are so glad to be back and have missed all of our lovely clients and look forward to welcoming new clients!

Appointments can be booked online by clicking ‘Click here to Book Online’ or by completing the ‘Book an Appointment’ form or by telephone on 01604 406180. Please Note: we will be able to offer appointments for facials and all face treatments from 1st August 2020!

We are so grateful for your continued support and we would ask you to note that full payment of treatments are required at the time of booking and a PPE/Additional Hygiene Measures surcharge of £3 will be applicable per client, per visit at present.

With a view to ensuring we are all keeping safe, please complete and submit a ‘Client Health Questionnaire’ form prior to arriving at Fong Day Spa. Upon your arrival, you will be asked to wash and sanitise your hands, receive a touch free temperature check and be issued with a face mask to wear. Please do let us know if you are unable to wear a face mask prior to your arrival.

Please note a minimum of 48 hours’ notice will be required for cancellations and refunds will not be issued for ‘no shows’ as this has a detrimental effect on our business. We therefore respectfully ask you to not make an appointment if you have experienced any cold or flu symptoms in the last 14 days or been in contact with anyone with these symptoms in the last 14 days, to enable us to maximise your safety and the safety of others at this difficult time.

We sincerely look forward to seeing you soon!