Clients Health Check-In
For Today’s Service
Date
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Month
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Day
Year
Date
Time of scheduled appointment
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:
Hour
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Minutes
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AM/PM Option
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
I have not been diagnosed with or cared for someone diagnosed with COVID-19 in the past two weeks
Agree
I have not shown symptoms of COVID-19 or come in close contact with anyone exhibiting these symptoms in the past two weeks.
Agree
I have not traveled outside of my immediate daily routine for the past two weeks.
Agree
I do not have a cough, fever, chills, shortness of breath, or loss of taste or smell.
Agree
If I begin to show symptoms of COVID-19 within the next two weeks, I will contact my stylist.
Agree
I will follow all posted salon rules to keep myself, my stylist and those around me safe.
Agree
I understand that by receiving services i am putting myself at risk, however I agree to not hold Nimbus Salon Responsible for any illness or injury that could occur.
Agree
Signature
Submit
Should be Empty: