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CLIENT HEALTH QUESTIONNAIRE

PRIOR TO THE START OF MY SERVICES, I CONFIRM THAT:

I have not been diagnosed with or cared for someone diagnosed with covid19 in the past two weeks.
I have not shown symptoms of covid-19 or come in close contact with anyone exhibiting these symptoms in the past two weeks.
I have not traveled outside of my immediate daily routine for the past two weeks.
I do not have a cough, fever, chills, shortness of breath, or loss of taste or smell.
If I begin to show symptoms of Covid-19 within the next two weeks, I will contact my stylist.
I will follow all posted salon rules to keep myself, my stylist and those around me safe.

PRINTED NAME:
DATE:
PHONE NUMBER:
Printable form version click here.