I understand that the novel coronavirus causes the disease known as COVID-19. I understand the novel coronavirus has a long incubation period during which the carriers of the virus may not show not show the symptoms and may still be contagious.
 
I understand that physical distancing of 6 feet may not be possible while in the salon receiving services.

I understand that I must sanitize my hands before entering the salon and I must wear a mask that covers my mouth and nose while in common areas. I will minimize touching of hard surfaces such as door handles, dryers, products, styling tools. and countertops will be wiped after each client.
 
I confirm that I am not currently positive for novel coronavirus.
 
I confirm that I am not waiting for the results of a laboratory test for the novel coronavirus.
 
I verify that I have not returned from any country outside of the US, whether by car, air, bus or train in the past 14 days.
 
I verify that I have not been identified as a contact of someone who has test positive for the novel coronavirus or been asked to self-isolate by any Department of Health, or any other government agency.
 
I confirm that I am not presenting with any of the following symptoms of COVID-19 indentified by the CDC
            Fever > 38C, or 100F, chills or body aches
            Cough
            Sore Throat
            Shortness of breath
            Difficulty breathing
            Flu-like symptoms
            Runny Nose
            Loss of smell or taste
 
I confirm that I am not in high risk category for increased illness or death from COVID-19, including : diabetes, cardiovascular disease, hypertension, lung disease including moderate to severe asthma, being immunocompromised (including transplant recipient), having active malignancy or over the age of 65.

I understand that for the safety of everyone, my temperature will be check before the services are started.  

I understand that I may be unable to proceed with services at Bella Coiffure Beauty Studio LLC, if deemed unsafe to myself or hairstylist

I understand I may NOT bring children or anyone else who does not have an appointment into the salon.
 
I understand the stylist at Bella Coiffure Beauty Studio LLC, will do everything possible to minimize the spread of COVID – 19, but will not hold stylist responsible should I contract the COVID – 19.
 
I will immediately notify the salon if I contract the virus within two weeks following my visit.
 
I verify that the information I have provided on this form is truthful and accurate.