GUIDE Intake Form

Due to the infectious nature of COVID_19, this form must be completed before each hair appointment at GUIDE. 
- Please answer these questions truthfully and do everything asked so we can do our best to protect each other. Thank you!
If you have any questions or concerns, please reach out to guidefrontdesk@gmail.com

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* 1. Please Enter Your Contact Information

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* 2. Have you been tested for COVID?

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* 3. Are you experiencing any of the following symptoms?

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* 4. Please Answer Yes or No to the following. (please reschedule your appointment, or reach out to us ASAP if you answered yes to any questions)

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Have you experienced any cold or flu like symptoms within the last 14 days?
Have you been in contact with anyone who has experienced cold or flu like symptoms within the last 14 days?
Have you been in contact with anyone with a confirmed or pending case of COVID19 within the last 14 days?
Have you done any air travel, domestic or international, within the last 14 days?
Have you traveled to any places with a high infection rate, where people have not been isolating, or have you been in any groups of people where social distancing was not observed within the last 14 days?
Do you spend time around anyone considered high risk, such as elderly or immunocompromised family members, or are you high risk yourself? (If so please reach out to us at guidefrontdesk@gmail.com)

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* 5. What precautions have you taken to limit your exposure to the virus?

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* 6. Enter the date of your appointment, thank you for your time and see you soon!

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