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Take your beauty to new heights with JB Esthetics Memberships!

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FACIAL INTAKE FORM

COVID-19 Pre-Screening

Are you currently waiting on the results of a COVID-19 test?
Yes
No
Have you experienced any of the following symptoms in the past 48 hours:
Have you had any signs of a fever in the past 24 hours or had a temperature that has elevated 100.0F or greater?
Yes
No
Within the past 14 days, have you been in close physical contact with anyone who test positive with cov-19?
Yes
No

Identification

This is required, this is for your protection and mine.

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