Safety - Style Room 23

Please Wait Until 24 Hours Before
Your Appointment To Submit Form

CLIENT HEALTH QUESTIONNAIRE

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 have not traveled outside of my immediate daily routine for 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 and those around me safe.*

Full Name*

Confirm Name*

Appointment Date*

Today's Date*

Please Wait Until 24 Hours Before
Your Appointment To Submit Form