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      © Elanele 2011:                         10 Market Square -  Stony Stratford -  Bucks -  MK11 1BE:    01908 566565:                       www.elanele.co.uk:                                  PAH WEB DESIGN
          Corona Virus (COVID-19)
   HS 017 Health Check Questionnaire
01908 566565
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01908 566565
Refer A Friend link to printable form
Refer a friend and both of you are rewarded, just simply download and complete the form from the link below. What are you waiting for? 
Refer your friend and once they have had their first treatment as a Thank You, we will send you a £5.00 voucher to spend on your next treatment or product purchase. Your friend will also receive a £5.00 reduction off their first treatment.
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Updated: 24th February 2021 at 10:18

As the situation with Coronavirus (Covid-19) develops, we all need to be thinking of ways to keep ourselves and our families safe.

Here at Elanele Beauty Center we're doing all we can to keep both Clients and staff as safe as is possible, we are following Government and WHE advice and we will constantly update this information and our Practices & Procedures as and when required. Stay Safe!
As part of our new health & safety protocols at Elanele Beauty Center in Stony Stratford, we are asking all clients to please complete this questionnaire 24 hours prior to your  beauty treatment. We are doing this to safeguard our clients and our team, so please be as accurate as possible with your answers,.  Thank you.
HOME TELEPHONE:
MOBILE TELEPHONE:
FIRST NAME:
LAST NAME:
EMAIL ADDRESS:
HEALTH CHECK QUESTIONNAIRE
WHEN IS YOUR APPOINTMENT?
DATE:
TIME:
Mikia:
Georgina:
Zoe:
Please let us know if you have experienced any of the symptoms listed below by clicking on the relevant boxes. If you are feeling unwell, please cancel your appointment immediately and seek medical advice. We will reschedule your appointment once your period of isolation is over.
A new continuous cough


A high temperature


Difficulty breathing


A loss of, or change in, your normal sense of taste or smell


Are you or is anyone you live with awaiting a result on a test for COVID-19?


Have you or has anyone you live with tested positive for COVID-19 in the last 14 days?


Do you have a cold?
YES    
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
Who Are You Booked In With?
All information we collect from you will be held confidentially and in compliance with GDPR along with your normal consultation forms.
Click on capture box above to change capture if you can't read it, Capture is case sensitive, please type  exactly what you see.
Click for new image
(Use this format: 20/12/20)
YES
NO
(No Spaces)
(No Spaces)
 
IMPORTANT INFORMATION;
PLEASE COMPLETE THIS FORM 24 HOURS PRIOR TO YOUR APPOINTMENT
(Use 24hr format: 13.30 )