RazorChic Brand
COVID-19 Pandemic Hair Treatment Consent Form
I consent to receive haircare services from [RazorChic Brand] during the COVID-19 outbreak.
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Intials
I understand that based on what is currently known about COVID-19 the spread is thought to occur mostly from person-to-person via respiratory droplets among close contacts. I understand that close contact can occur from being within approximately 6 feet of someone with COVID-19 for a prolonged period of time or by having direct contact with infectious secretions from someone with COVID-19. I understand that carriers of COVID-19 may not show symptoms but may still be highly contagious. I understand that due to the unknowns of this virus, the number of other clients that have been in the salon and the nature of the services performed here. I understand that salon services have the potential to include aerosol-generating procedures as well as anticipated splashes and sprays, which are some of the ways that COVID-19 can be spread.
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Intials
I understand that the symptoms listed below are representative of COVID-19: • Fever - • Dry Cough • Shortness of Breath • Temperature • Persistent pain or pressure in the chest • Bluish lips or face
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Initials
Temperature During Visit ( Any temperature above 99°F we will ask you to reschedule.
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Initials
I confirm that I do not display or currently have any of the symptoms that are representative of COVID- 19, which are outlined above.
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Initials
I understand that all travelers arriving from a country or region with widespread ongoing transmission, as outlined by the CDC, should stay home for 14 days to practice social distancing and monitor their health after their arrival. • I confirm that I have not traveled to any of the countries or regions with widespread ongoing transmission (Level 3 Travel Health Notice) in the past 14 days.
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Initials
I confirm, to the best of my knowledge, that I have not had close contact with an individual diagnosed with COVID-19 in the past 14 days.
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Full Name ( First & Last)
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By signing you consent to services.
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