Health Questionnaire

I have not been diagnosed with or cared for someone diagnosed with COVID-19 in the past two weeks.

I have not shown symptoms of COVID-19 or come in contact with anyone exhibiting these symptoms in the past two weeks.

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

I do not have a cough, fever, chills, shortness of breath, or loss of taste or smell.

I will follow all posted salon rules and requests from Rapunzel’s Staff to keep myself, my services provider and those around me safe.