COVID Form

Bella Salon & Spa
COVID-19 Screening Questions

Have you had a cough?

Have you had a fever above 100.1 degrees Fahrenheit?

Have you been in close contact with anyone with these symptoms or anyone who has beendiagnosed with COVID-19 in the past 14 days?

Have you had shortness of breath?

Do you have a headache, sore throat, new loss of taste, smell or muscle pain? If yes to two of these symptoms this question is a YES.

RELEASE OF LIABILITY WAIVER - State of Maryland

I hereby agree that Bella Salon & Spa employees has a proper sanitation and disinfection plan in
place and is not responsible for any accidental transmission of COVID-19 that could occur by being
in their business or within close proximity of each other. I agree that if I become symptomatic within
14 days of my visit, I will notify the business immediately.

To accept this contract, type your name below

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