COVID-19 Pandemic Service Consent Form
Health Verification
Name
*
First Name
Last Name
Date
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-
Month
-
Day
Year
Date Picker Icon
Name of Stylist or Technician
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Amanda
Julia
Heather
Emily
Karianna
Celeste
Miranda
Lynn
Sarah
Ashley
Not Sure
Name of stylists
*
First Name
I knowingly and willingly consent to having hair and/or spa service(s) during the COVID-19 pandemic at The Beauty Bar.
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by checking this box I understand and accept this statement.
To prevent the spread of contagious viruses and to help protect each other, I understand that i will have to follow the salon's strict guidelines including wearing a mask to my appointment and covering my face with a towel during shampoo service.
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by checking this box I understand and accept this statement.
I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. I know that the CDC, OSHA, and Maine State Board of Cosmetology recommend social distancing of at least 6 feet at all times. I understand blow dry service is not offered at this time.
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by checking this box I understand and accept this statement.
I understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of our services, that I have elevated the risk of contracting the virus by merely being in The Beauty Bar.
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by checking this box I understand and accept this statement.
I understand the COVID-19 virus has many symptoms including cough, shortness of breath, fever, chills, sore throat, headache, lost of taste or smell and if I display any of these symptoms I will cancel my appointment or I will not be allowed to enter The Beauty Bar.
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by checking this box I understand and accept this statement.
I verify that I have not traveled in or outside the United States In the past 14 days. I have not visited any Countries that have been affected by COVID-19
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YES
NO
Have you had a cough or a sore throat? Have you had a fever or feel feverish? Do you have shortness of breath? Do you have loss of taste or smell? Have you been around people exhibiting any of these symptoms in the last 14 days? Are you living with anyone who is sick or quarantined? Have you been outside of the state in the last 14 days?
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YES
NO
In-salon Temperature Policy
I’m willing to take a temperature check if necessary anytime during my visit to The Beauty Bar or before the services are started, and I agree not to come to the salon with the following symptoms of COVID-19 listed below: Fever- Temperature 99+ 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 The Beauty Bar Salon & Spa.
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Yes
Signature
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Clear
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