Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

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

Yes

No

Are you suffering from any flu like symptoms? *

Yes

No

Are you experiencing any fever/temperature symptoms? *

Yes

No

Are you experiencing any difficulty in breathing, shortness of breathe? *

Yes

No

Did you consult a Doctor or other medical practitioner? *

Yes

No

How are you feeling health wise? *

Well

Unwell

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

Yes

No

I am aware that not all hair colour is possible and it might take a few appointments to achieve my desired look. *

Confirm

Due to salons being shut for 14 weeks your hair may need a double application of colour and or colour correction. I am aware that this will cost more and take more time than usual. *

Confirm

I am aware that if I am 15 min late for my appointment I might have to reschedule due to strict time restrictions based on government guidelines. *

Confirm

I am aware that due to strict government guidelines I must wear a clean face covering in order to enter the salon and I will not be able to have my hair done without one. *

Confirm