Covid-19 Wellness Check In

Please stop and read!

The Covid-19 Wellness Check-in is for all existing clients who have already filled out a Covid-19 Waiver. New clients and existing clients returning for the first time since we re-opened in May should fill out a Covid-19 Waiver form.

Please be honest in responding to the Wellness Check-in questions. This form should be filled out the morning of your appointment. If you have questions or concerns please reach out to your stylist.

Simply Glamorous Salon and Spa COVID-19 WELLNESS CHECK-IN

First Name

Email Address

Last Name

Stylist Name

I HAVE EXPERIENCED THE FOLLOWING SYMPTOMS IN THE LAST TWO WEEKS: • Fever of 99 degrees or higher or chills • Cough • Loss of taste or smell • Chest Pains or shortness of breath • Nausea or vomiting • Fatigue or body aches • Sore throat • Congestion or runny nose • Upset stomach

Yes

I HAVE come in contact with someone who has had COVID-19 symptoms or tested positive in the last 4 weeks

Yes

I HAVE traveled outside of the country or traveled to any other state currently listed on the New York State quarantine list or that has been on the list in the last 2 weeks.

Yes

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!