Covid 19 Guidelines - barberellabeauty

Covid Health Questionnaire

Have you been diagnosed with or cared for someone diagnosed withCOVID-19 in the past two weeks? *

yes
no

Have you shown symptoms of COVID-19 or come in close contact with anyone exhibiting these symptoms in the past two weeks? *

Yes
No

Have you traveled outside of my immediate daily routine for the past two weeks? *

Yes
No

Do you have a cough, fever, chills, shortness of breath, or loss of taste or smell? *

Yes
No

If you begin to show symptoms of COVID-19 within the next two weeks, will you contact your stylist? *

Yes
No

Will you follow all posted salon rules to keep you, your stylist and those around you safe? *

Yes
No

Name *

First

Last

Mobile Number *

Date / Time *

Date

Time

Please enter the date and time of your appointment here.

Checkboxes *

I agree to share this information with Barberellabeauty.com management and staff

By submitting this form you are allowing this information to be shared with Barberellabeauty.com management and staff in preparation for your upcoming appointment. This form will remain on file with Barberellabeauty.com for up to 60 days after submission.

Contact

Info

PROUDLY USING