COVID-19  Client Revisit Waiver
This form is to be used as an individual client record for Shear Designs II salon guest; & each visit for their scheduled service appointment. It is required to ensure that during the COVID-19 Pandemic, there are no symptomatic signs of the virus during this service visit.
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Email *
First Name *
Last Name *
Date of service *
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DD
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Client's Temperature This Service Visit: *
1. Have you been in contact with anyone that has been diagnosed with COVID-19 virus, and been symptomatic within the past 14 days? *
2. Have you had the following symptoms within the past 14 days? *
3. Have you had a fever? *
4. Have you had a dry cough? *
5. Have you had a sore throat? *
6. Have you had shortness of breath? *
7. Have you had a loss of taste or smell? *
8. Have you been around anyone exhibiting these symptoms within the past 14 days? *
Select your stylist name *
Date *
MM
/
DD
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YYYY
Signature (Write Below) *
Submit
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