Name *

First Name

Last Name

Do you have a temperature 100.4 or greater? *

Yes

No

Have you experienced shortness of breath or had trouble breathing? *

Yes

No

Have you recently had a loss or reduction in taste or smell? *

Yes

No

Do you have a sore throat? *

Yes

No

Have you been in contact with someone who has tested positive for COVID-19? *

Yes

No

Have you tested positive for COVID-19? *

Yes

No

Have you been tested for COVID-19 and are awaiting results? *

Yes

No

Have you traveled outside the United States by air or cruise ship in the past 14 days? *

Yes

No

Have you traveled within the United States by air, bus or train within the past 14 days? *

Yes

No

Policies *

-All team members and guests are required to wear masks. If you do not have a mask, you will not be able to enter the facility. -Please come alone. Friends, family, children and/or anyone else should not accompany you on your visit. -When you arrive, please text us (817-442-0800) before entering the salon. We will notify you when your service provider is ready. -We are conducting temperature screening on site. If you have a fever, you will not be permitted to remain in the facility. -Any physical contact between guests and team members should be limited to that which is essential to perform services. -Hand/scalp massages and beverage services are discontinued at this time. -Retail products should only be handled by team members. -Those who may be considered to be at higher risk of serious symptoms, including but not limited to those with compromised immune systems, respiratory diseases or disorders, should consult a physician before obtaining salon services.

I fully understand and acknowledge the above information, risks and cautions regarding a compromised immune system and have disclosed to my provider any contributing conditions in my health history.

I understand that air travel significantly increases my risk of contracting and transmitting the COVID-19 virus. And the CDC recommends social distancing of at least 6 feet for a period of 14 days to anyone who has traveled by air.

I understand that I will contact the salon, as well as my primary care physician, if I develop any COVID-19 symptoms within the next 14 days.

Date *

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