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COVID-19 Screening Form

As per the Ministry of Health, you must answer the following questions prior to entering our salon.

Do you have any of the following new or worsening symptoms or signs? *

Symptoms should not be chronic or related to other known causes or conditions. Choose "yes" in the following question if any/all of the symptoms listed are new, worsening, and not related to other known causes or medical conditions.​

Do you have any of the aforementioned new or worsening symptoms or signs?
Have you travelled outside of Canada in the last 14 days?
In the last 14 days, has a public health unit identified you as a close contact of someone who currently has COVID-19?

Thanks for submitting!

  • Fever and/or chills - Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher 

  • Cough, barking cough (croup) or shortness if breath- Continuous, more than usual, making a whistling noise when breathing, not related to other known causes or conditions (for example, asthma, post-infectious reactive airways, COPD) 

  • Decrease or loss of smell or taste - Not related to other known causes or conditions (for example, allergies, neurological disorders) 

  • Sore throat or difficulty swallowing- Not related to other known causes or conditions (for example, seasonal allergies, acid reflux) 

  • Runny or stuffy/congested nose - Not related to other known causes or conditions (for example, seasonal allergies, being outside in cold weather) 

  • Headache that’s unusual or long lasting - Not related to other known causes or conditions (for example, tension-type headaches, chronic migraines) 

  • Digestive issues like nausea/vomiting, diarrhea, stomach pain - Not related to other known causes or conditions (for example, irritable bowel syndrome, menstrual cramps) 

  • Muscle aches and/ or extreme tiredness that is unusual - Not related to other known causes or conditions 

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