top of page

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.

Name*

Email Address*

Appointment Type

Question 1 Answer:

Question 2 Answer

Question 3 Answer:

Client Signature

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 aviella_alohastylist@yahoo.com 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?

ALOHA...WELCOME TO MAUI, HAWAII

To Check Availability: 808-357-3504

bottom of page