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COVID POLICY AGREEMENT

For the Safety of both Blowout clients and staff, please review, fill out and sign the form below prior to your appointment.

Again, if you answer "yes" to any of these questions we cannot serve you and you will need to reschedule your appointment.

Name *

First

Last

Email *

Phone

Have you or a member of your immediate family been tested or diagnosed with COVID-19? *

Have you experienced any of the following symptoms within the last 14 days: *

NONE
Cough
Shortness of Breath
Difficulty breathing
Sore throat
Fever
Cold
Tightness in chest
Nausea
Muscle pain or a loss of taste and or smell

Have you traveled outside the country within the last 14 days? *

Do you live with anyone who has had COVID-19 within the last 14 days? *

If I happen to test positive within the next 14 days for COVID-19 I will contact the Salon immediately. *

Yes, I will

If you have answered yes to any of these questions we cannot serve you and you will need to reschedule your appointment.

Captcha *

=

Name

GET IN TOUCH

973-656-1004

10 Cattano Ave, Morristown, NJ 07960

me@jacquelinecicala.com

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