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Client Health Questionnaire
Client Health Questionnaire
PRIOR TO THE START OF MY SERVICE, I CONFIRM THAT:
Consent
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I have not been diagnosed with or cared for someone diagnosed with COVID-19 in the past two weeks.
*
Consent
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I have not shown symptoms of COVID-19 or come in close contact with anyone exhibiting these symptoms in the past two weeks.
*
Consent
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I have not traveled outside of my immediate daily routine for the past two weeks.
*
Consent
*
I do not have a cough, fever, chills, shortness of breath, or loss of taste or smell.
*
Consent
*
If I begin to show symptoms of COVID-19 within the next two weeks, I will contact my stylist.
*
Consent
*
I will follow all posted salon rules to keep myself, my stylist and those around me safe.
*
Signature
*
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Name
*
Email
*
Phone Number
Date
*
MM slash DD slash YYYY
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Client Health Questionnaire
PRIOR TO THE START OF MY SERVICE, I CONFIRM THAT:
Consent
*
I have not been diagnosed with or cared for someone diagnosed with COVID-19 in the past two weeks.
*
Consent
*
I have not shown symptoms of COVID-19 or come in close contact with anyone exhibiting these symptoms in the past two weeks.
*
Consent
*
I have not traveled outside of my immediate daily routine for the past two weeks.
*
Consent
*
I do not have a cough, fever, chills, shortness of breath, or loss of taste or smell.
*
Consent
*
If I begin to show symptoms of COVID-19 within the next two weeks, I will contact my stylist.
*
Consent
*
I will follow all posted salon rules to keep myself, my stylist and those around me safe.
*
Signature
*
Reset signature
Signature locked. Reset to sign again
Name
*
Email
*
Phone Number
Date
*
MM slash DD slash YYYY
Δ
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