RONNY@STUDIO 203 QUESTIONNAIRE

RONNY@STUDIO 203 QUESTIONNAIRE

My Priority is Your Safety, Sanitation and Wellness
Name:

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Best way to reach you:

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Which best describes how you feel about your upcoming visit?

I am looking forward to my appointment with Ronny.I’m excited, but want to spend as little time in Public, and be in and out.
If you have anything you would like to mention, please let me know here:
Salon Service Pre-Screening
CLOSE CONTACT IS DEFINED AS
- Being within approximately 6 feet of a Covid-19 case.
- Close contact can occur when caring for, living with, visiting, or sharing a healthcare waiting area or room with a Covid-19 case.
- Having direct contact with infectious secretions of the Covid-19 case (ex: being coughed on)
1. HAVE YOU BEEN IN CONTACT WITH ANY PERSON DIAGNOSED (CONFIRMED BY TEST) WITH COVID-19 IN THE LAST 14 DAYS?*

YesNo
2. HAVE YOU BEEN AROUND ANYONE THAT HAS HAD A FEVER, COUGH, SORE THROAT, MUSCLE ACHES OR SHORTNESS OF BREATH IN THE LAST 14 DAYS?*

YesNo
3. ARE YOU EXPERIENCING ANY LOWER RESPIRATORY ILLNESS (COUGH, shortness of breath, and/or fever)*

YesNo
4. I UNDERSTAND THAT IN ORDER TO RECEIVE AND SERVICE BY RONNY KLINDT AT STUDIO203, I MUST WEAR A FACE MASK, WASH MY HANDS UPON ENTERING SALON AND USE HAND SANITIZER PROVIDED.*

I Agree
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Salon Service Pre-Screening