New Client Consultation Form

COVID-19 Pandemic Hair Treatment Consent Form
Name *

First Name Last Name
Date *

Month Day Year
Name of Stylist for upcoming visit *
Name of stylists *

First Name
I knowingly and willingly consent to having hair and salon service(s) during the COVID-19 pandemic. *

by checking this box I understand and accept this statement.
Neither myself or any other member of my household has experienced any of the following symptoms related to Covid 19 in the last 14 days- Fever, Severe Cough, Shortness of Breath, or Loss of Taste or Smell. *

by checking this box I understand and accept this statement.
In-salon Temperature Policy

I’m willing to take a temperature check during my visit to the salon before the services are started. I understand that any temperature reading above 99.5 degrees will require appoinment to be rescheduled. I agree not to come to the salon with the following symptoms of COVID-19 listed below: Fever, Temperature, Shortness of breath, Loss of sense of taste or smell,Dry cough, Runny nose, Sore throat
I understand, read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I understand that this document is to provide the best possible guest experience when visiting Form Salon *

Yes No, I would like to reschedule my appointment
Signature *

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Should be Empty:

COVID-19 Pandemic Hair Treatment Consent Form