Client screening Form

Do you/they have congestion or a runny nose?

Yes

No

Are you/ they having shortness of breath or other difficulties breathing?

Yes

No

Do you/they have a sore throat?

Yes

No

Any other flu like symptoms, such as gastrointestinal upset?

Yes

No

Have you/they experienced recent loss of taste or smell?

Yes

No

Are you/they in contact with any confirmed COVID-19 virus positive people?

Yes

No

Have you/they traveled in the past 14 days to any regions affected by COVID-19

Yes

No

Do you/they have congestion or a runny nose?

Yes

No

Are you/ they having shortness of breath or other difficulties breathing?

Yes

No

Do you/they have a sore throat?

Yes

No

Any other flu like symptoms, such as gastrointestinal upset?

Yes

No

Have you/they experienced recent loss of taste or smell?

Yes

No

Are you/they in contact with any confirmed COVID-19 virus positive people?

Yes

No

Have you/they traveled in the past 14 days to any regions affected by COVID-19

Yes

No

In the last 72 hours I confirm that I am not presenting any of the following symptoms of COVID-19: Fever, chills, fatigue, headaches, and muscle and/or body aches.

Yes

No

Salon South Client Screening Form

Please print and fill this paperwork out 24 hours before your appointment.

Everyone inside the salon must bring a mask and wear it, we will not supply one.

Please call from the parking lot when you arrive before entering the salon. We are limiting the amount of people in the salon.

Thank you for your cooperation.