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COVID-19 ONLINE QUESTIONNARE
Please complete this form prior to your appointment at the salon.
First Name
Last Name
Email
I have not been diagnosed with or cared for someone diagnosed with COVID-19 in the past two weeks.
I have not shown symptoms of COVID-19 or come in close contact with anyone exhibiting these symptoms in the past two weeks.
I do not have a cough, fever, chills, shortness of breath or loss of taste or smell.
If I begin to show symptoms of COVID-19 within the next two weeks, I will contact my stylist.
I will follow all posted salon rules to keep myself, my stylist or therapist and all those around me safe.
Are you experiencing any flu symptoms?
No
Yes
Have you had your vaccination? if yes, please write the date. If no, leave it blank.
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