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Andrea Rose Skincare
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Covid 19 Safety
Health Declaration
Please fill out the following health declaration form in order to receive services. Submissions are valid up to 24 hours prior to the servce..
First Name
Last Name
Email
My body temperature is lower than 98.6°F/ 37.5°C
Are you experiencing any flu symptoms?
No
Yes
Date
Initials
I confirm that the information given in this form is true
Submit
Thanks for submitting!
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