Name: Ross Hair Studio & Clinic
Address: 1st Floor, Rathfarnham, Dublin 14, 54 Main Street, IE
Telephone: 01 492 5073

COVID-19 QUESTIONNAIRE

Name*

Address/Eircode*

Mobile No*

Date of Appointment*

To ensure the safety and health of all people interacting with Ross Hair Studio and Clinic, clients and visitors must complete this declaration form prior to entering or on arrival at our salon. If you have been abroad in the previous 14 days of your appointment date, with exception to Northern Ireland, I will be unable to see you for the first week after you arrive home and you will need a negative Antigen test on the day of your appointment if it falls on the second week after you arrive home. If you have had Covid-19 or symptoms of Covid-19 or have been a close contact and you have had your booster shot more than 7 days ago, I will only be able to see you with a negative Antigen test on the day of your appointment if it falls within 10 days from day one of the close contact.

Have you visited any countries outside Ireland, excluding Northern Ireland in the past 14 days?*

Have you been identified as a close contact of anyone with Covid 19 in the past 10 days.*

If you answer "Yes" to either of the above 2 questions, please call the clinic on 01-4925073 before attending your appointment.

How are you feeling healthwise now ?*

Message

NOTE: When in salon, please adhere to our in-salon standard processes/procedures regarding infection control, i.e., hand washing/hand sanitising and general
coughing/sneezing etiquette.

Contact Ross Hair Studio & Clinic Today to Book a Private and Confidential Hair Loss Consultation

01 492 5073 01 492 5073