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Loren's Hair Studio COVID-19 Client Revist Form
This form is to be used as an individual client record for salon guest each time they visit the salon or shop 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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First Name
*
Your answer
Last Name
*
Your answer
Client's Temperature This Service Visit:
Your answer
Do you have any of the following symptoms present today: Fever, Shortness of Breath, Runny Nose, Loss of sense of taste or smell, Dry Cough, Sore Throat, Chills, Shaking with Chills, Muscle Pain, Head Ache
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Yes
No
Have you been in contact with anyone that has been diagnosed with the COVID-19 virus during the time between this service visit and my previous service visit?
*
No, I have not
Yes, I have
Signature (Write Below)
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