Consultation Form

Question Title

* 1. Name:

Question Title

* 2. Date of Birth:

Date

Question Title

* 3. Address:

Question Title

* 4. Emergency Contact Number:

Question Title

* 5. Do you suffer from any of the following:

Question Title

* 6. I hereby confirm that neither I, nor anyone within my household are showing Covid-19 symptoms, nor have been around anyone who has tested positive in the last two weeks. I do not have a high temperature, a new consistent cough or loss of taste or smell.

Question Title

* 7. Consent and agreement
I certify that the above statements are true and correct, therefore I give my consent for my treatment to be carried out.

Question Title

* 8. Please go to our website  to view our privacy policy:  https://www.crantockbay.co.uk/privacy-policy/

Question Title

* 9. Due to the nature of our business and while we take steps to minimise the risk of cross contamination, we cannot guarantee that any of our products are safe for people with nut, wheat or other severe allergies.

0 of 9 answered
 

T