COVID-19 information page

During these unprecedented times we will continue to tailor our services to prioritise your safety. The nature of our services however makes “social distancing” impossible, but we have put in place measures to make your visit to Carte Blanche “COVID-19” safe as best possible.

Please help us by following these suggestions:

What to expect when visiting Carte Blanche

1. Book your appointment as per usual

I will send out this information at the time of the the appointment being made.

2. On the day before your appointment I will:

Make sure you understand the consent to treatment during the COVID-19 pandemic, which will be sent to you electronically.

Ask about any current symptoms suggestive of COVID-19 and possible exposure.

Do a telephonic or video consultation, ask all the questions as per usual to assure the proposed treatment in suitable, make sure there is no contra-indictions and answer any questions you may have about the treatment.

We will attempt to keep your time spent in the clinic to a minimum to further reduce exposure.

As an added precaution I will take your temperature with a “no touch” thermometer when you arrive at the clinic.

3. Upon arrival we will kindly ask you to:

Ring the doorbell, come through the gate and wait at the outside waiting area where we will come and meet you.

Wash your hands

Wear a face mask for the duration of your visit

Proceed directly to the treatment couch/upstairs to the hair salon.

4. To assure your safety from Carte Blanche’s side I will:

Disinfect all surfaces between patients.

Wash hands and wear gloves prior to your treatment.

Wear a face mask at all times; with safety glasses depending on the treatment.

Prepare the products required prior to your arrival to minimise time spent in the clinic.

Products for home use will be delivered to your home directly from the pharmacy.

5. Consent

I will ask you to digitally sign the consent from specific to your treatment to further minimise contact.

6. Payment

Instead of paying in the clinic, an electronic invoice will be emailed to you at the time of the telephonic consultation or following the appointment if adjustments are required.

specific covid-19 consent

I ______________________ (patient name) understand that I am opting for an elective medical procedure.

I understand that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organisation and that COVID-19 is extremely contagious and is believed to spread by person-to-person contact; and, as a result, social distancing is recommended. This is not entirely possible with my proposed treatment, however, I am satisfied that safety measures are in place to minimise risk as much as possible, and patient contact will be kept to an absolute minimum in line with medical need. ______ (initials)

I understand the Management and Clinical Staff are closely monitoring the COVID-19 situation and have put in place reasonable preventative measures aimed to reduce the spread of COVID-19. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 by virtue of proceeding with treatment. I hereby acknowledge and assume the risk of becoming infected with COVID-19 through this elective medical treatment/procedure/surgery, and I give my express permission to proceed. _____ (initials)

I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. I understand that COVID-19 can cause additional health risks, some of which may not currently be known at this time, in addition to those risks associated with the medical treatment/procedure/surgery itself. _____ (initials)

I have been given the option to defer my medical treatment/procedure/surgery to a later date. However, I understand all the potential risks, including but not limited to the potential short-term and long-term complications related to COVID-19, and I would like to proceed with my desired medical treatment/procedure/surgery. _____ (initials)

I confirm that I am not presenting with any of the following symptoms of COVOID-19 listed below:

• Fever

• Shortness of Breath

• Loss of Sense of Taste or Smell

• Dry Cough

• Runny Nose

• Sore Throat

• ___________ (Initials)

I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. I confirm that I have not travelled in the past 14 days ________ (initials)

I confirm that if I develop COVID-19 symptoms following my medical treatment/procedure/surgery, or a known contact of mine develops symptoms, I will immediately inform the Carte Blanche to enable appropriate measures to be put in place and contact tracing to commence _____ (initials)

Patient name

Signature

Clinician name

Signature

Date