COVID-19 Questionnaire COVID-19 FORM Healthy Hair Studio request you to fill out the following questionnaire before entering the premises as a result of COVID-19 (Coronavirus) within Ireland.Name First Last Date Date Format: MM slash DD slash YYYY Time of Appointment : HH MM AM PM SignaturePlease select either YES or NO Have you experienced any COVID-19 symptoms in the last 14 days?YesNoHave you been in contact with any person (s) who has laboratory confirmed COVID-19 diagnosis in the last 14 days?YesNoHave you travelled internationally in infected countries within the last 14 days?YesNoAre you in self-isolation?YesNo
