COVID-19 Client Self Assessment

To ensure the Safety & Health of all people interacting with Luminess Skin & Laser Clinic clients and visitors must complete this declaration form prior to entering the clinic or on arrival at the clinic.

If you indicate to us that you have symptoms of COVID-19 OR you have been abroad in the last 14 days with exception to Northern Ireland you will be required to either restrict your movements or self-isolate.

Where this is the case, you are prohibited from entering the clinic and are advised to seek professional medical help/assistance in line with HSE Guidelines.

Where * denotes a required field.

    Please tick the appropriate box below

    * Have you visited any countries outside Ireland excluding Northern Ireland?

    * Are you suffering any flu-like symptoms?

    * Are you experiencing any difficulty in breathing or shortness of breath?

    * Are you experiencing any fever/temperature symptoms?

    * Did you consult a Doctor or other medical practitioner?

    * Have you been in contact with someone who is confirmed to COVID-19 or has visited an affected region in the past 14 days?

    * How are you feeling health wise?