Brad's Hair Studio Client Questionnaire
The purpose of this form is to take precautions to keep the staff and clients who enter BHS safe. These answers will be used for the sole purpose of contact tracing and screening prior to entering our building. Otherwise, this information will be kept confidential.
Stylist or Technician Name
Amber (Massage Therapist)
Leslie (Nail Tech)
I don't know
In the past 14 days, have you HAD CONTACT with anyone known to have or have been tested for COVID-19?
If you answered "yes" to the question above, please enter the date and location information:
In the past 14 days, have you HAD CONTACT with anyone with the following symptoms: fever higher than 100.4 , persistent dry cough, shortness of breath (for unknown reason), or fatigue (for unknown reason)?
In the past 14 days, have YOU had any of the following symptoms: fever higher than 100.4 , persistent dry cough, shortness of breath (for unknown reason), or fatigue (for unknown reason)?
BHS Client Rules & Procedures
By typing my name, I electronically sign and acknowledge that I read the BHS Client Rules & Procedures and have answered all prior questions truthfully to the best of my knowledge: (those under 16 years of age require a parent of guardian's signature)
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