Client Pre-Screen Form COVID-19 Safe Studio
An easy, convenient way to gather and save all of our clients' information to ensure a safe studio service visit. Once submitted, this form will automatically save.

By completing and submitting this form, you are knowingly and willingly consenting to having beauty services performed during the COVID-19 Pandemic and you agree to adhere to all safety and sanitation protocols now required by The Portland Girl.
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Full Name *
Phone Number (without dashes) *
In the last 24 hours, have you had a new or worsening cough? *
In the last 24 hours, have you had a fever? *
In the last 24 hours, have you had shortness of breath? *
In the last 24 hours, have you had new loss of smell and/or taste? *
Have you been in close contact with anyone with these symptoms or anyone who has been diagnosed with COVID-19 in the last 14 days? *
I agree by providing my name below, I am in essence rendering my signature in acknowledgement of the completed statements on this form and that all information is accurate as of the date of this form.  Additionally, by providing my signature, I release The Portland Girl from any and all liability for unintentional exposure or harm due to COVID-19. *
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