COVID-19 SCREENING QUESTIONNAIRE AND CONSENT
Please complete the following form before coming to your appointment at Flower Spirit Natural Beauty. This information is being collected as a health and safety measure in order to assist contact-tracing efforts during the COVID-19 pandemic.
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Name *
Phone number *
Email address *
Today's Date *
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Do you have any of the following symptoms? *
Required
Have you travelled outside Canada in the past 14 days and you are under mandatory quarantine? *
Required
Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? *
Required
*CONSENT
if you answered YES to any questions or present any COVID-19 symptoms, please cancel your appointment and rebook again in two weeks.
By submitting this form you verify that the information provided on this form is truthful and accurate.
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