Jojo's Beauty Bar: COVID-19 Client Health Questionnaire

I know we are all doing our best to keep our community happy and healthy. In preparation for your upcoming appointment, OHA, Associated Skin Care Professionals and Sola Studios request that you answer the following questions before your scheduled appointment. Thank you for your patience and understanding.

Please read entire questionnaire. Please give me at least 48 hours notice if you need to reschedule or cancel your appointment to avoid cancelation fees. I will not charge a cancelation fee for emergencies or illness.

To avoid bank fees I am not taking debit/credit cards. Please prioritize check or cash payment for services. Products and online purchases may be paid for with venmo if needed.

Name*

First NameLast Name

Phone Number*

Email (for appointment confirmation)

Referred by

Who can I thank?

In the last 10 days have you been in close unmasked contact with anyone with active COVID-19 or Coronavirus-type symptoms?*

Yes (please reschedule)No

In the last 72 hours have you had any respiratory, cold or flu-like symptoms?*

Yes (please reschedule)No

In the last 72 hours have you experienced a fever of 100.3°F or higher?*

Yes (please reschedule)No

In the last 72 hours have you experienced a sore/scratchy throat not due to seasonal allergies?*

Yes (please reschedule)No

Are you currently experiencing shortness of breath not due to physical exertion or Asthma?*

Yes (please reschedule and call your doctor)No

In the past 14 days have you traveled in a commercial plane, cruise ship, bus or train where you did not properly wear a mask during travel?*

Yes (please reschedule)No

Did you read each question before answering?*

YesNo (go back and read it please)

Day of Appointment:

Electronically fill out and submit COVID Health Questionnaire.
To prevent excess "people traffic" our front doors are locked 24/7. Please wait in your car or outside building. I will text you at the time of your appointment to meet me at the front door.

For now, you can not bring guests (friends, partners, children, etc) to your appointment. You are welcome to bring your caregiver. If you plan to bring a caregiver, text me 503-421-5621 with your caregiver's name and text number so I can send them a COVID Health Questionnaire to fill out. The same safety guidelines will apply to your caregiver for your appointment.

Please prioritize check or cash payment for services. I will provide sanitized change and pen. Retail and online products can be paid for using Venmo if needed.

Consent for Treatment:

I understand esthetics involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. Filling out and submitting this form will represent my signature that I acknowledge I am aware of the risks involved when receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless Jojo Haren and Jojo's Beauty Bar and Pearl Esthetics, LLC from any claims related thereto. I give my consent to receive treatment from Jojo Haren at Jojo's Beauty Bar and/or Pearl Esthetics, LLC.

Today's Date*

Fill out and submit this form on the day of your appointment, Not before.

I will always go the extra mile to keep myself and my clients safe from potential exposure to Coronavirus and other infectious diseases and BBP. I am trained and certified with American Spa, Barbicide and the state of Oregon in sanitation and infection prevention in the Esthetic and Advanced Esthetic industry.

COVID-19 is a highly contagious virus that spreads from person to person. In addition to the current explicit sanitation measures, Jojo's Beauty Bar and Pearl Esthetics, LLC has implemented additional preventative measures to further reduce the spread of novel coronavirus or any other virus or bacterial-type infection. However, these best practices still offer no guarantee regarding your potential risk of being exposed.

If you are not vaccinated: In the past 7 days have you attended any indoor social events or crowded space where you were unmasked and unable and/or unwilling to keep a 6 foot social distance from other non-vaccinated unmasked person(s) who live outside your own household or bubble?*

Yes (please reschedule)NoI am fully vaccinated 💉