ALOHA...WELCOME TO MAUI, HAWAII
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PLEASE COMPLETE COVID-19 QUESTIONNAIRE BEFORE YOUR NEXT SCHEDULED APPOINTMENT
HAVE YOU RECENTLY BEEN IN CONTACT WITH ANYONE WHO HAS TESTED POSITIVE FOR Covid-19? If YES, please STOP HERE.
I understand that I have the responsibility to immediately notify Hawaii health and my professional service provider should my responses on the questionnaire change.
** If unable to electronically submit , please print, complete and email to [email protected] ot you may call 808-357-3504.
Contact Information
AVIELLA ALOHA BEAUTY
Phone: 808-357-3504
QUSTION 1:
HAVE YOU RECENTLY TRAVELED TO A RESTRICTED AREA THAT IS UNDER A LEVEL 2, 3, or 4 Travel Advisory according to the U.S. State Department? Including: China, Italy, Iran and most countries in Europe.
QUESTION 2:
In the last 14 days have you traveled outside your normal, daily routine?
QUESTION 3:
Do you have new or worsening onset of any of the following symptoms: fever, cough, shortness of breath, runny nose, sore throat, chills, body aches, fatique, headache, loss of taste/smell, eye drainage, congestion?