Classic Hair and Beauty Cpt Covid-19 Salon Services Consent Form

By submitting this form, you agree to have hair, skin, or body services during the pandemic.

Client Name*

Last Name*

By checking the boxes, you confirm that you agree with the following statements:*

I understand that I have a risk of contracting virus during the service.I agree to obey the rules of the salon during my appointment in order to minimize the spread of viruses.I confirm that I have not been diagnosed with COVID-19 last 14 days.I verify that I am not waiting for the laboratory test results for COVID-19.I consent to having my temperature screened with a non-contact thermometer.

Do you have any of these symptoms? - cough, shortness of breath, high fever, muscle pain, body ache, nausea, loss of taste/smell*

YesNo

Within 14 days, have you been in contact with anyone that has COVID-19 symptoms or get infected?*

YesNo

Are you living with anyone that is get infected or quarantined due to COVID-19?*

YesNo

I agree not to visit the salon for any of the services provided if I have the symptoms of COVID-19. I acknowledge that the information I have given in this consent form is accurate and complete. By signing below, I confirm that I understand and agree to all terms and statements in this form.

Parent/Guardian Name (if applicable)

Create your own automated PDFs with JotForm PDF Editor

Date*

Date

Signature*

Client Signature

______________________________

Client Signature

Month Day*

Year*