COVID-19 Prescreening Questionnaire

Please complete the form prior to your appointment.

If you are experiencing even a mild cough, sore throat, congestion, respiratory issues, fever or body aches, please inform me and we can reschedule.

If you have any questions, please do not hesitate to ask via beautybyphybe@gmail.com or
647-913-1943

Name

First Name

Last Name

Do you currently have one or more of the COVID-19 symptoms below that are new or worsening?

Symptoms should not be chronic or related to other known causes or conditions: - Fever and/or chills - Cough - Shortness of breath - Decrease or loss of smell or taste - Fatigue and/or muscle aches/joint pain - Nausea/vomiting and/or diarrhea - Extreme tireness

In the last 14 days, have you travelled outside of Canada and been told to quarantine (per the federal quarantine requirements)?

In the last 10 days, have you tested positive on a rapid antigen test or home-based self-testing kit?

If you have since tested negative on a lab-based PCR test, select "No."

I understand that if I present any of these symptoms upon arrival to the studio/during my appointment, I will be asked to reschedule

By typing your name below, you are electronically certifying this document just as if you would physically sign it if it was on paper

BEAUTY BY PHYBE

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BEAUTY BY PHYBE

BEAUTY BY PHYBE

COVID-19 PRESCREENING QUESTIONNAIRE

BEAUTY BY PHYBE

COVID-19 Prescreening Questionnaire

BEAUTY BY PHYBE