COVID-19 Screening Form

IMPORTANT:

All patrons must complete this form on the day of their appointment prior to entry of the Salon.  Forms must be submitted no sooner than 24hrs prior to the your scheduled appointment.  

We would like to thank all of our Patrons for their continued understanding and support during these times. 

1. Are you currently experiencing any one of the symptoms below that are new or worsening? Symptoms should not be chronic or related to other known causes or conditions.

Fever and/or chills? Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher.
Cough or barking cough (croup)? Not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have.
Shortness of breath? Not related to asthma or other known causes or conditions you already have.
Sore throat? Not related to seasonal allergies, acid reflux, or other known causes or conditions you already have.
Difficulty swallowing? Painful swallowing not related to other known causes or conditions you already have.
Decrease or loss of smell or taste? Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have.
Pink eye? Conjunctivitis not related to reoccurring styes or other known causes or conditions you already have.
Runny or stuffy/congested nose? Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have.
Headache? Unusual, long-lasting not related to tension-type headaches, chronic migraines, or other known causes or conditions you already have.
Digestive issues like nausea/vomiting, diarrhea, stomach pain? Not related to irritable bowel syndrome, menstrual cramps, or other known causes or conditions you already have.
Muscle aches? Unusual, long-lasting (not related to a sudden injury, fibromyalgia, or other known causes or conditions you already have).
Extreme tiredness? Unusual, fatigue, lack of energy (not related to depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have).
Falling down often? For older people.
2. Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
3. In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19?
4. In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? If you already went for a test and got a negative result, select "No."
5. In the last 14 days, have you travelled outside of Canada? If you are exempted from federal quarantine as per Group Exemptions, Quarantine Requirements under the Quarantine Act, select “No”