Pre Salon Visit Health Analysis
Please note the following questions have been asked on behalf of Diane Carreiro and Meraki Hair Studio as per the guidelines of Health Canada in response to stopping the spread of COVID-19.

We are taking all precautions with the intake of every client, health history reviews, and ministry standard sanitation and disinfection practices. Note: all of these heath guidelines listed below are followed by Diane and/or Meraki Hair Studio employees by the same standard and affirm the same both inside and outside of the salon.

Failure to answer these questions honestly will result in the refusal of your entrance to Meraki Hair studio and cancellation of your current appointment. Note: the personal information shared below will be kept amongst Meraki Hair Studio members and Diane only.
Email *
First and Last Name *
Date of your up coming appointment? *
MM
/
DD
/
YYYY
Do you, or any of your household members, currently display any of the symptoms of COVID-19? * *
No
Yes
Fever
Dry Cough
Difficulty Breathing
Have you, or any of your household members, been diagnosed with COVID-19 in the past 30 days? *
Have you, or any of your household members, knowingly been exposed to anyone with COVID -19 in the past 30 days? *
Have you, or any of your household members, travelled outside of the country or to any city of our own that is or has been considered a "hot spot" for COVID -19 in the past 30 days? *
I understand that Diane and/or Meraki Hair Studio cannot be held liable for exposure to the virus or any other contagion caused by misinformation on this form or health history provided by each client. *
By agreeing to the statements above, you (the client’s name listed on the form) are releasing Diane and Meraki Hair Studio from any liability for the unintentional exposure and/or harm of COVID-19. *
Please sign your first and last name below, along with the date you completed this form (ex. Diane Carriero, June 1 2020). *
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