COVID-19 Treatment Consent Form: Sassy Nails Boutique
To be completed at each visit. Please be truthful with your answers.
Name
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First Name
Last Name
Date
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Month
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Day
Year
Date Picker Icon
Name of stylists
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First Name
I knowingly and willingly consent to having a salon service(s) during the COVID-19 pandemic.
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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 adhere to Sassy Nails Boutique strict guidelines. This includes the mask requirement, personal items and hands sanitized,temperature check performed, hand washing up to the elbows for 20 seconds, no extra items, food, or guest during the service, no COVID-19 or allergy symptoms displayed, etc.
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by checking this box I understand and accept this statement.
I confirm that I have not been diagnosed with or cared for someone diagnosed with COVID-19 in the past two weeks.
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by checking this box I understand and accept this statement.
I confirm that i have not shown symptoms of COVID-19 or come in close contact with anyone exhibiting these symptoms in the past two weeks
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by checking this box I understand and accept this statement.
I confirme that i have not traveled outside of my immediate daily routine for the past two weeks routine.
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by checking this box I understand and accept this statement.
I confirm that I have not traveled outside the United States In the past 14 days to countries that have been affected by COVID-19
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YES
NO
I confirm that if I begin to show symptoms of COVID-19 within the next two weeks, I will contact my technician.
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YES
NO
In-salon Symptoms Policy
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 Sassy Nails Boutique
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Yes
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