COVID-19 Self Assessment Questionnaire If you are vaccinated, and want to allow us to see your card, we can put you in our system as being vaccinated. You DO NOT need to fill this out anymore. BUT, please continue to self monitor and if you have a fever, don't feel well, or live with someone infected, please reschedule. First: Anyone who enters the salon who does not feel safe or comfortable has the right to leave, without being penalized for the appointment being missed.
Please read this entire assessment as it has important information in it.

*Disposable mask: Please wear or bring a disposable mask if you are having a color service.

All clients and staff will be required to wear a mask.

No food or drink is allowed. Please keep all personal items to a minimum. Please no purses, just credit card, keys, cell phone, and cash. We are asking that no phone calls be taken during your time at the salon.

Please take into consideration that many of our employees take care of elderly parents, have compromised immune systems, or have children to take care of. If you are or suspect you are sick please cancel your appointment, and reschedule for when you are symptom free for 72 hours after symptoms are gone, and no fever reducer has been taken.

This questionnaire is to be completed online. This is your 48 hour prior to appointment pre-screening. Another screening will be performed upon arrival. Please arrive 10 minutes early, call from your car, and we will meet you outside the door.

We do not have a waiting area. Clients will process outside, or in their car (unless receiving a service that does't allow for this) limiting contact and you will be more comfortable and able to remove your mask in your car.

If you are having a color service performed, please wear an old shirt, as protective smocks are not available at this time, but you will have a cape.

Please be aware that if your stylist needs to mix additional color, there will be a one time fee of $10.00 for your first initial visit. We have also had a slight price increase.

For the protection of our nail clients, we have made zippered mesh bags with a file, buffer, and orange wood stick, that will be purchased for $3.00 and the client will bring it with them to all of their nail appointments.

Lastly, when we are all reunited with one another, lets please talk about happy things, and leave the outside world out for the time you are with us. We have been away from each other for far too long.

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Name- First and Last *
Phone Number Without Dashes *
APPOINTMENT DATE HERE PLEASE (SO IMPORTANT) MUST PUT 2021 Example 02/23/2021 If this date is not accurate, your name will not appear on the daily log, and you may have to fill out a form upon arrival. *
Zip code *
By checking the boxes, you confirm that you agree with the following statements: *
1. Do you have any of these symptoms? - cough, shortness of breath, high fever, muscle pain, body ache, nausea, loss of taste/smell? If answering YES, you will need to reschedule your appointment unfortunately. *
2. Within 14 days, have you been in contact with anyone that has COVID-19 symptoms or infected? If answering YES, you will need to reschedule your appointment unfortunately. *
3. Are you living with anyone that is infected or quarantined due to COVID-19? If answering YES, you will need to reschedule your appointment unfortunately. *
4. If you are having barbering services (beard trim, shave) where your mask will need to be removed. Do you agree to not hold Manahawin Hair and Nail Design Inc, D.B.A Simply Hair responsible for possible exposure to COVID-19. *
5. Have you traveled out of state in the past 14 days? Specifically to states with rising COVID-19 cases: Alabama, Alaska, Arkansas, Arizona, California, Colorado, Florida, Georgia, Guam, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. If you answer "YES" to this question, for the safety of our employees and clients, you will need to reschedule your appointment for 14 days after your return. We are sorry for any inconvenience this may have caused. *
I agree not to visit the salon for any of the services provided if I have any of the symptoms of COVID-19, if I live or care for someone with COVID-19 confirmed or suspected . I acknowledge that the information I have given in this consent form is accurate and complete. By signing below, I confirm that I have read, understand, agree to all of the terms and statements in this form, and I do not hold Manahawkin Hair and Nail Design Inc. D.B.A. Simply Hair liable if I develop COVID-19 due to visiting the salon. Having salon services is my choice and I choose to have them performed. *
Please sign by typing your full name *
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