Curve Hair Studio - Health Screening
Answering this is required before each appointment. Your information will not be shared with anyone other than a written request by Region of Waterloo Public Health.
Email address *
First and Last Name *
Phone Number *
Mailing Address *
I have been in close physical contact with someone with a confirmed or suspected COVID-19 diagnosis in the last 14 days. *
I consider myself to be in a high risk group due to my age or underlying medical issues.
Clear selection
I or someone in my household has experienced a fever, cough, shortness of breath, sore throat, muscle aches (not exercise related) or other cold/influenza-like symptoms in the last 14 days. *
I or someone in my household woke up feeling unwell today. *
I have or someone in my household has traveled outside of the province in the last 14 days. *
I agree that my answers above are true to the best of my knowledge. I agree that my information will be stored securely should contact tracing be necessary. *
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