Thank you for including a visit to You Doll You in your upcoming plans. Please use the questionnaire below to submit important information about your current health. Each customer and employee is required to do this before each planned trip to You Doll You Eyelash Extensions.

First Name *

Last Name *

Mobile Phone *

Email Address *

Have you experienced any cold or flu-like symptoms in the past 2 weeks. Including fever, chills, exhaustion, cough, sore throat, respiratory illness, or difficulty breathing? *No, I have experienced no symptomsYes, I have experienced some symptomsI have a cough unrelated to contagious disease

Are you coughing occasionally or frequently for any reason at all? *Not applicable, I have no coughYes, I am experiencing seasonal allergiesYes, I am getting over an illness unrelated to COVID-19Yes, I have a cough with unknown origin

Have you been exposed to any sick individual in the past two weeks? *No, I have not been exposedYes, I have been exposedI'm not sure at this moment

Do you have a mask and will you wear it while in our place of business? *Yes, I have a mask and will wear itNo, I have no mask

Submit

Please do not fill in this field.