Full Name: *
Email Address *
Date of appointement *
Have you been presenting a Temperature above 98.7 degrees? *
Have you been presenting Shortness of breath? *
Have you been presenting a Loss of taste or sense smell? *
Have you been presenting a Dry cough? *
Have you been presenting a Sore Throat? *
Have you been around or are you living with anyone who has presented any of the symptoms above in the last 14 days? *
Have you been with anyone who is sick or quarantined in the past 14 days. *
Have you traveled domestically within the United States by commercial airline, bus, or train within the past 14 days. *
To prevent the spread of contagious viruses and to help protect each other, I have read and completely understand the salons protocols and that I will follow them at all times. *
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