COVID_19 Client Service Health Screening
By completing and submitting this form, you are knowingly and willingly consenting to have beauty or barber services performed during the COVID-19 pandemic and you agree to adhere to all safety and sanitation protocols now required by my salon and studio service provider.
Street Address Line 2
State / Province
Postal / Zip Code
enter 2020 for year
My baseline pre-visit temperature must be below 100 degree Fahrenheit in order to receive a service.
My temperature is below 100
Are you experiencing/have experienced any symptoms in the last 14 days (including but not limited to: Fever, Cough, Sore throat, Respiratory illness, Difficulty breathing)?
Have you been in close contact with anyone who has been diagnosed or infected with COVID-19 in the last 14 days?
Have you been tested for COVID-19 and are waiting for your test results within the last 5 days?
I am fully vaccinated. My goal is to make every guest feel safe and comfortable in my salon studio. Please choose the option that feels most comfortable to you.
I am fully vaccinated and would prefer to not wear a mask during my service.
I would prefer to wear a mask.
I would like for my stylist to wear a mask
I am OK with my stylist not wearing a mask
Should be Empty: