COVID-19 Screening Questionnaire

This tool provides basic information only and contains recommendations for COVID-19 screening for entry into Bella Vita Aesthetics. It is not to be used as a clinical assessment tool or intended to take the place of medical advice, diagnosis or treatment. Where the document includes references to legal requirements, it is not to be construed as legal advice.

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Your Health

    Please advise us of any health problems you have or have had? This will help us with any health conditions that may be a contraindication to your treatment. For example, Autoimmune disease, cold sores, epilepsy, etc.
  • Product and Treatment History

  • Your Skin

  • General

  • Daily eating habits

  • Beverages

  • Digestion

  • Stress

  • Sleep

  • Women Only


Book Your Appointment

Click on Book Now to schedule your next appointment at Bella Vita Aesthetics.

Scroll to Top