CLIENT DECLARATION FORM
I do not have a cough, cold or any flu like symptoms, including sore throat, hay fever, sinusitis, a post nasal drip, body aches or fever
I have not been tested or in contact with someone who is waiting for a COVID-19 test result in the past 14 days
I have not been overseas or in contact with anyone who has been overseas within the past 14 days prior to my appointment
I have not been in contact with anyone who has flu like symptoms within the last 14 days
I agree to a temperature check and to abide by all the health and hygiene protocols stipulated by Karen Kaufman Skin Care
I have had an Influenza vaccination this year
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133 Bambra Road
Caulfield, Victoria 
Australia 3162

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