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Covid 19 Intake Questionnaire

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Covid 19 Intake questionnaire

Covid Intake questionnaire for beauty salon

Page 1

Please answer the following questions to help us ensure the safety of our staff and clients.

Email*

Full Name*

Phone Number*

Date of Birth*

Select date

Gender*

Ethnicity*

Race*

Employment Status*

Marital Status*

10.

Living Situation*

11.

Household Income*

Description:This Covid intake questionnaire is designed for beauty salons to ensure the safety of their clients and staff. It includes questions related to Covid-19 symptoms, travel history, and exposure to infected individuals. By filling out this form, clients can help the salon take necessary precautions to prevent the spread of the virus.

During the Covid-19 pandemic, it is crucial for businesses to take necessary precautions to ensure the safety of their clients and staff. Beauty salons are no exception. This Covid intake questionnaire is specifically designed for beauty salons to gather information about their clients' health and travel history to prevent the spread of the virus. The form includes questions related to Covid-19 symptoms, recent travel, and exposure to infected individuals. By filling out this form, clients can help the salon take necessary precautions to prevent the spread of the virus. This questionnaire is an essential tool for beauty salons to maintain a safe and healthy environment for their clients and staff.

Patient Name*

Patient ID*

Date of Birth*

Select date

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Patient's Full Name*

Patient's Date of Birth*

Patient's Address*

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I understand that telemedici...*

I have read and understand the above statement.*

Yes

Full Name*

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Patient Name*

Patient ID*

Date of Birth*

Select date

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Patient's Full Name*

Patient's Date of Birth*

Patient's Address*

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I understand that telemedici...*

I have read and understand the above statement.*

Yes

Full Name*

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What is your name?*

What is your age?*

What is your hair type?*

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Patient Name*

Patient Date of Birth*

Patient Address*

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Client Name*

Date of Birth*

Address*

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Client Name*

Client ID*

Date of Service*

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First Name*

Last Name*

Date of Birth*

Select date

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What is your name?*

What is your age?*

What date did you visit our clinic?*

Select date

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