COVID-19 Questionnaire

PLEASE READ

After you answer to all the questions in this questionnaire, please type your full name, email address & phone #, and click SEND button. If you answer “YES” to any of the questions, please DO NOT come or enter the salon. If you experience any symptoms or answer “YES” to any of these questions, you must immediately contact your health care professional for recommended next steps.

Have you tested positive for COVID-19 in the past 14 days? Answer Yes/No*

Have you came into close contact with a person who tested positive for COVID-19 in the past 14 days? Answer Yes/No.*

Have you feel or recently felt feverish? Answer Yes/No*

Have you had cough,shortness of breath,sore throat,nausea,vomiting,diarrhea,tiredness,chills,headaches,body aches,confusion,or loss of taste/smell?Y/N*

Full Name*

Email*

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