CV-19 Safe Salon Client Revisit Form
Email address *
First Name *
Last Name *
Do you have any of the following symptoms present today: Fever, Shortness of Breath, Runny Nose, Loss of sense of taste or smell, Dry Cough, Sore Throat, Chills, Shaking with Chills, Muscle Pain, Head Ache *
Have you been in contact with anyone that has been diagnosed with the COVID-19 virus during the time between this service visit and my previous service visit? *
Signature (Write Below) *
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