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