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MEREDITH BROOKE SALON

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Covid-19 Wellness Form

How are you feeling today?

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Your Signature

Date

I declare that the info I’ve provided is accurate & complete

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BE THE FIRST TO KNOW ABOUT SPECIAL SALES AND NEW ARRIVALS

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Meredith Brooke Salon

5000 Monroe Rd.

charlotte, nc 28205

(704) 915-2553

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