Guest Questionnaire | u4ia Salon Spa

Guest Health Questionnaire

Please fill out the following health questionnaire to confirm your upcoming appointment booking.

If you cannot check all the indicated fields, you must call the salon to speak with one of our staff.

Full Name

I have not been diagnosed with COVID-19 in the past two weeks.

I have not cared for someone in my home who is diagnosed with COVID-19 in the past two weeks.

I have not travelled outside of my immediate daily routine for the past two weeks.

I do not have: cough, fever, chils, shortness of breath, or loss of taste or smell.

If I begin to show symptoms of COVID-19 within the next two weeks I will contact the salon.

I will follow all posted salon rules to keep myself, my stylist and those around me safe.

Date

Initials

I confirm that the information given in this form is true

Success!

Thank you for completing our health questionnaire. Watch your email for your appointment confirmation which includes details for when you arrive for your appointment.

We want to thank you for your continued understanding as we navigate the 'new normal'.