COVID-19 Pandemic Spa & Beauty Service Consent Form
Please read, answer all questions and submit to be serviced.
Do you knowingly and willingly consent to have beauty and spa services during the COVID-19 pandemic?
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NO
YES
Do you understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious?
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NO
YES
Do you understand it is impossible to determine who has COVID-19 and who does not have it given the current limits in virus testing?
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NO
YES
Do you understand that due to the frequency of visits of other clients, the characteristics of the virus, and the characteristics of services, that you have an elevated risk of contracting the virus simply by being in a beauty bar/beauty salon?
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NO
YES
Do you confirm that you are not presenting any of the following symptoms of COVID-19 listed: Fever-Temperature, Shortness of Breath, Loss of Sense Of Taste, Loss of Sense Of Smell, Dry Cough, Runny Nose, Sore Throat ?
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NO
YES
Do you 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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NO
YES
Do you agree that to prevent the spread of contagious viruses and help protect each other, you will have to follow the Salon’s strict guidelines?
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NO
YES
Do you understand that air travel significantly increases your risk of contracting and transmitting the COVID-19 virus?
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NO
YES
Do you understand that the CDC, 0SHA and Florida Board of Cosmetology and Barber’s recommend social distancing of at least 6 feet?
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NO
YES
Have you traveled outside the United States in the past 14 days to countries that have been affected by COVID-19?
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NO
YES
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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FIRST NAME, LAST NAME
Temperature During Visit ( Any temperature above 99°F we will ask you to reschedule)
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Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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-
Area Code
Phone Number
Signature
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By signing you consent to services.
Date and Time Signed
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