Are you suffering from any cold, flu or virus symptoms?(also applicable at the time of your appointment)
Do you have any type of physical injury or have you had a recent surgery (within last 12 months) or scar tissue?
Are you suffering from any of the following?
Females only :
Please tell us where you heard about us?


Our clinic will open subject to government guidelines. AyurCare UK has completed the Covid-19 Clinical Safety Course accredited by the International School of Aesthetics as well as a Local Authority Risk Assessment.  Staff will adhere to the new and updated working standards as required.  

Please bring your own drinks/water bottle otherwise we are only able to offer beverages in disposable cups at the moment. 


Clients are not requested to wear a face covering whilst visiting the clinic.

Please respect the clinic’s sanitation and hygiene standards and processes posted within the clinic and shared by employees.

You are required to complete and submit the above information before attending

This form is required for all appointments including consultations.


If you have any questions or worries about giving your details or experience any problem in completing this form, please contact us by telephone.

Do NOT come to the clinic if you are feeling unwell or exhibit symptoms of COVID-19, including:

  • A persistent, dry cough

  • Shortness of breath or difficulty breathing

  • A fever of 100.4° or higher

  • Chills

  • Muscle pain

  • Sore throat

  • New loss of taste or smell

  • If you are under an isolation or quarantine order/directive




We may require to contact you for further details prior to your appointment

Copyright © 2018 AyurCare UK - All Rights Reserved.

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01276 686 281 

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