COVID-19 Questionnaire
For the safety of our staff and clients we are taking extra measures to keep the salon & spa a safe environment. Therefore, anyone coming into Dolce Vita Salon & Spa will be screened and part of our
screening process will include asking the following questions:
Name: *
Phone Number: *
Email: *
Todays Date: *
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Have you had a fever (100.4 Degrees F or higher) or felt feverish in the last 72 hours? *
Have you been in close contact with a confirmed case of COVID-19? *
Are you experiencing any respiratory symptoms including a runny nose, sore throat, cough, or shortness of breath? *
Are you experiencing any new muscle aches or chills? *
Have you experienced any new change in your sense of taste or smell? *
Are You HIGH RISK? *
Have you been in close contact with anyone who has been diagnosed or infected with Covid19 in the last 14 days?? *
Have you traveled in the past 14 days either Internationally (outside the U.S.) By cruise ship, or Domestically (within the U.S.) outside of NH, VT, or ME on public transportation (e.g., bus, train, plane, etc.). *
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