Covid-19 Questionnaire & Release Form
Our client's, as well as your families health and safety remains our first priority here at The Final Cut Hair Studio & Lash Reveal. Due to the outbreak of Covid-19, We at The Final Cut Hair Studio & Lash Reveal are taking all extra precautions, including monitoring the intake of our client's. We have ramped up our sanitation and disinfection procedures per recommended by CDC as well as our state officials. We are continuing to monitor the situation closely and will make any changes at any time as needed.
We ask at this time you limit your visit to only the client, unless the client is a minor. We also ask that you wear a mask to your appointment at this time, if you do not have a mask, we will provide one for you at an additional charge of $1 per mask.
We also ask if you think there is a possibility you may have been around, exposed or work around anyone who may have/had the virus in the last 30 day's that you reschedule your appointment and wait out the quarentine amount of time.
We ask that you please text us when you have arrived for you appointment, if you are early, we will let you know when to enter the salon as to not make you sit in the hallways and risk unneccasary exposure.
We are taking all necassary steps to avoid contamination and spread of the virus, but with the virus being airborne there is a chance it can be contracted through airborne particals. Which is why we ask that you please wear a mask at this time.
We appreciate your support during this time and your participation is very much appreciated and important to us. Our priority is to protect you, your family, as well as ours and any other client's that may be entering the building. Thank you so much and we are happy to be here to service you.
Self Decleration By Client &/Or Visitor:
Name:*
First Name Last Name
Phone Number*
Area Code Phone Number
Parent/Guardian:
First Name Last Name
Have you been in close contact or cared for someone with a confirmed case of Coronavirus in the last 30 day's?*
Yes No
Have you traveled on an airplane in or outside of the US in the last 30 day's?*
Yes No
Have you been on a cruise in the last 30 day's?*
Yes No
Have you been in close contact with anyone who has traveled in or outside of the US in the last 30 day's?*
Yes No
Are you currently experiencing or have you experienced any of the listed symptoms within the last 30 day's including (cough, shortness of breath, fever, sore throat, respiratory illness, fatigue)?*
Yes No
Are you currently experiencing or have you experienced any of the listed symptoms within the last 30 day's including (Chills, shaking, muscle pain, headache, loss of taste or smell)?*
Yes No
Current Temperature
If the answer is "Yes" to any of the questions, access to the salon will be denied
By submitting I hereby confirm that the information I have given above is true to the best of my knowledge. I understand my personal information will be kept confidential.
I understand the above symptoms and I affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 30 day's.
I affirm that I, as well as all household members, have not been diagnosed with covid-19 in the last 30 day's.
I affirm that I, as well as all household members, have not knowignly been exposed to anyone diagnosed with covid-19 within the last 30 day's.
I affirm that I, as well as all household members, have not traveled in or outside of the country or by plane within the last 30 day's.
I understand that this business and my stylist/lash artist cannot be held liable for any exposure to the virus or anyother contagion caused by misinformation on this form or health history provided by each client.
I understand that my stylist/lash artist is following all precautions and disinfection practices but due to the nature of this virus that it doesn't mean I cannot contract the virus but that it will greatly reduce my chance of it, being that it is an airborne virus.
By signging below I agree to each above statement and release The Final Cut Hair Studio & Lash Reveal from any and all liability for the unintentional exposure or harm due to covid-19.
I also understand the salon has the right to refuse service to any client's at anytime, for any reason if they feel there is a risk involved.
Signature*
Clear
Today's Date:*
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Date
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Covid-19 Questionnaire & Release Form