JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
COVID-19 Questionaire
Please fill the form in below prior to your appointment
Sign in to Google
to save your progress.
Learn more
* Indicates required question
First Name & Last Name
*
Your answer
Email Address
Your answer
Phone Number
*
Your answer
Your Stylist
*
Stephanie
Kim
Tiffany
Michelle
Chelsey
Ben
Maya
Heidi
Ciara
Emma
Coughing, Sore Throat and/or painful swallowing, Fever or chills?
*
Yes
No
Have you or anyone in your household traveled outside of Canada in the last 14 days?
*
Yes
No
Have you or anyone in your household been in contact in the last 14 days with someone who is being investigated or tested positive for COVID-19
*
Yes
No
Client Signature (All clients under the age of 12 must have a parent/guardian sign)
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
