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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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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Date of service
*
MM
/
DD
/
YYYY
Client's Temperature This Service Visit:
*
Your answer
1. Have you been in contact with anyone that has been diagnosed with COVID-19 virus, and been symptomatic within the past 14 days?
*
Yes
No
2. Have you had the following symptoms within the past 14 days?
*
Yes
No
3. Have you had a fever?
*
Yes
No
4. Have you had a dry cough?
*
Yes
No
5. Have you had a sore throat?
*
Yes
No
6. Have you had shortness of breath?
*
Yes
No
7. Have you had a loss of taste or smell?
*
Yes
No
8. Have you been around anyone exhibiting these symptoms within the past 14 days?
*
Yes
No
Select your stylist name
*
Choose
Debria
Angela
Leneda
Yvette
Pauline
Johnnie
Lytiia
Angelina
Lape
Edwina
Kristiana
Paula
Date
*
MM
/
DD
/
YYYY
Signature (Write Below)
*
Your answer
Submit
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