"COVID-19 SERVICE FORM"
Do you knowingly and willingly consent to have hair, nail and skin 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 it 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 hair, nail and skin treatments, that you have an elevated risk of contracting the virus simply by being in a 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-TemperatureShortness 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 agree that to prevent the spread of contagious viruses and help protect each other, you will have to follow this business 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 Louisiana 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
Is your temperature over 99%?
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NO
YES
Have you traveled domestically within the United States by commercial airline, bus, or train within the past 14 days?
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NO
YES
Name
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First Name
Last Name
Phone Number
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Area Code
Phone Number
Signature
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