COVID-19 Screening Form

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COVID-19 Screening Form

Cosmetic Specialist in New Jersey

Have you experienced the following symptoms in the last 72 hours?
Fever or chillsCoughingShortness of breath or difficulty breathingNew loss of taste or smellMuscle or body achesNONE OF THE ABOVE

I have not been in close contact with another person who has been diagnosed with or under investigation for COVID-19 within the previous 14 days.

I acknowledge that Rejuv Cosmetic Center & Spa cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, salon staff, and other salon clients and their families.

I knowingly and freely assume all such risks, both known and unknown, and assume full responsibility for my participation in any treatment provided by Rejuv Cosmetic Center & Spa.

Please note that you must acknowledge above statements before submitting the form.

COVID-19 Screening Form

Cosmetic Specialist in New Jersey

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COVID-19 Screening Form

COVID-19 Screening Form

Cosmetic Specialist in New Jersey