COVID-19 Screening Form
This form must be completed by ALL guest prior to being serviced. This form is to protect staff and guest alike as we adjust to the new norm. This along with heightened disinfectant precautions will allow us to limit the possibility of being exposed to COVID-19. We hope to see you soon! Stay Safe & Limit your activities!

** If you are unwell or have any flu-like symptoms please stay home.

***Upon submitting this form you acknowledge, although exposure is unlikely, that Salon Cheveux International and Team are not liable for any contact you may have to COVID-19.

Email address *
First & Last Name *
Date *
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Have you had any signs or symptoms of a fever in the past 24 hours such as chills, sweats, felt "feverish" or had a temperature that is elevated for you/ 100.0F or greater? *
Do you have any of the following symptoms? Cough, Shortness of Breath or Chest Tightness, Sore Throat, Nasal Congestion/Runny Nose, Myalgia (Body Aches), Loss of Taste and/or Smell, Diarrhea, Nausea, Vomiting, Fever/Chills/Sweats *
Have you or anyone you live with been in contact with someone with a confirmed diagnosis of COVID-19 within the last 14 days ? *
Have you or anyone you live with travelled to New York, New Jersey, Florida, California or any state with high COVID-19 activity? *
Are you or have you cared for someone who has been diagnosed with COVID-19 in the past 14 days? *
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