Client Health Questionnaire

I have not been diagnosed with or cared for someone diagnosed with COVID-19 in the past two weeks. *I Confirm

I have not shown symptoms of COVID-19 or come in close contact with anyone exhibiting these symptoms in the past two weeks. *I Confirm

I do not have a persistent cough, fever, chills, shortness of breath, or loss of taste or smell. *I Confirm

If I begin to show symptoms of COVID-19 within the next two weeks, I will contact my therapist. *I Confirm

I will follow all posted salon rules to keep myself, my stylist and those around me safe. *I Confirm

Full Name *Please enter your full name

Phone *Please enter your main contact number

Date *

Please confirm you have read through our terms & conditions *Yes, I agree with the privacy policy and terms and conditions.

Signature *

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