New Client Consultation Form

1

Date* This field is required.

Date

2

Name* This field is required.

First Name

Last Name

3

Phone Number* This field is required.

Please enter a valid phone number.

4

Prior to the start of my service, I confirm that:* This field is required.

I do not have a pending COVID-19 test.

I have not been diagnosed with or cared for anyone with COVID-19 in the past 2 weeks.

I have not shown signs or been in close contact with anyone that is exhibiting these symptoms: COUGH, FEVER/CHILLS, SHORTNESS OF BREATH, DIFFICULTY BREATHING, SORE THROAT, LOSS OF TASTE OR SMELL, FATIGUE, HEADACHE, CONGESTION, OR RUNNY NOSE, NAUSEA OR VOMITING OR DIARRHEA

I have not traveled outside of my immediate daily routine for the past two weeks.

If I begin to show symptoms of COVID-19 within the next two weeks, I will contact my stylist.

I will follow all posted salon rules to keep myself, my stylist, and those around me safe.

5

Signature* This field is required.

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