Health Awareness Survey

Please complete the following wellness questionnaire which is requred to be completed prior to your appointment. If you answered "YES", please check the box.

Has the client had a fever or above normal temperature (>100.4F) in the last 14 days?

Has the client experienced shortness of breath, trouble breathing or cough within the last 14 days?

Has the client experienced a runny nose, sore throat, or muscle pain in the last 14 days?

Has the client had any contact with another person exhibiting the above-mentioned symtoms in the last 14 days?

Has the client been tested positive for COVID-19 or is still waiting for results of a test?

Has the client been in contact with someone who has tested positive for COVID-19 or is still waiting for results, within the last 14 days?

Thank you! In being seen in my studio for permanent makeup services or training, as the guarantor, I agree to notify Delicate Touch Esthetics at 916-801-9859 within 14 days. Any of the above mentioned symptoms change or if the client becomes ill, or tests positive to COVID-19.