I Say Yes Salon & Spa COVID-19 Pandemic Consent Form for HairCare/SkinCare/Makeup

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By submitting the form below you agree to knowingly and willingly consenting to have Haircare/Skincare/Makeup service during the COVID-19 Pandemic. We reserve the right to refuse service if this form is not submitted.

Email *

Full Legal Name - Please write out name how it is spelled on your License, ID, or Passport *

Phone Number *

Have you received a positive COVID-19 test result in the past 14 days? *

Yes

Do you have any signs and symptoms of COVID-19? This includes fever or chills, shortness of breath, continuous cough, fatigue, headache, sore throat or muscles, body aches, congestion, runny nose, vomiting, diarrhea, or loss of sense of smell or taste? *

Yes

Do you live in a household with anyone who may have come in contact with a person who has experienced signs/symptoms OR received a positive COVID-19 test? *

Yes

Have you recently traveled to any region experiencing a high amount of COVID-19 cases - within the past 14 days? *

Yes

Have you recently been tested for COVID-19 - within the past 14 days? *

Yes

What was your results if you answered "Yes" to the last question?

Negative

Positive

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Have you EVER been diagnosed with COVID-19? If "Yes", please specify exactly when. *

Other:

By clicking "Yes" below I attest that my answers above are accurate to the best of my knowledge. *

Yes

Required

By clicking "Yes" below I affirm that I will notify I Say Yes Salon & Spa if there are any changes to my responses after completing this form, and before I arrive for my appointment. *

Yes

Required

By clicking "Yes" below I affirm that I will follow all current state, and CDC guidelines while at my appointment. *

Yes

Required

You can always learn more about COVID-19 and the current guidelines by visiting CDC.gov

A copy of your responses will be emailed to the address you provided.

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